Prenatal Flashcards
Review stages of pregnancy, signs of pregnancy, physical and psychological changes, prenatal tests, and complications. (92 cards)
1
Q
How many weeks is the first trimester of pregnancy?
A
week 1 to week 13
2
Q
At how many weeks is the second trimester of pregnancy?
A
week 14 to week 27
3
Q
At how many weeks is the third trimester of pregnancy?
A
week 28 to week 40
4
Q
At what week of gestation can the sex of the fetus be determined?
A
Sex of fetus determined at week 12 by ultrasound.
5
Q
What is the normal 1st trimester fetal heart rate?
A
160 - 170 beats per minute
6
Q
What is the normal heart rate of a fetus by the end of the 3rd trimester?
A
110 - 160 beats per minute
7
Q
What are some risk factors for a difficult pregnancy or loss of the fetus?
A
- age: <20 years old or >35 years old
- obesity
- abuse and violence
- diabetes or cardiac disorders
- drugs/smoking/alcohol
- medications
8
Q
How often are prenatal visits?
A
- every 4 weeks from confirmation of pregnancy until end of 2nd trimester
- every 3 weeks from 28 to 36 weeks (starting at 3rd trimester)
- then weekly until delivery
9
Q
What are the general assessments for every prenatal visit?
A
-
pregnant woman assessment:
- blood pressure
- weight
- urine screening for proteins (pre-eclampsia)
-
fetus assessment:
- fundal height (of woman)
- fetal ultrasound for heart tones and growth
10
Q
What is Nagele’s rule?
A
Nagele’s rule is calculating the due date of the baby:
- due date = + 9 months + 7 days (adjust the year) from the date of when the last period started
11
Q
Define:
Gravida and Para
A
- Gravida: the number of total pregnancies (including present one)
- Para: the number of births after 20 weeks
12
Q
What does GTPAL stand for?
A
- Gravida: number of pregnancies
- Term: births after 37 weeks
- Preterm: births before 37 weeks
- Abortions (miscarriages)
- Living children
13
Q
What is a presumptive sign of pregnancy?
A
- quickening (feeling movement of fetus)
- nausea/vomiting
- sore breasts
- missed period
14
Q
What is a probable sign of pregnancy?
A
A probable sign of pregnancy is a pregnancy test that comes back positive and the signs detected by the HCP such as:
- Heger’s sign
- Goodell’s sign
- Chadwick’s sign
15
Q
What is Heger’s sign?
A
A probable sign of pregnancy when the lower part of uterus starts to get soft at about week 6.
16
Q
What is Goodell’s sign?
A
A probable sign of pregnancy when there is softening of the cervix at about week 9.
17
Q
What is Chadwick’s sign?
A
A probable sign of pregnancy when the cervix turns a bluish-purple color at about week 6.
18
Q
What is ballottement?
A
A probable sign of pregnancy of when the fetus rebounds when the HCP presses on the uterus.
19
Q
What are Braxton-hick contractions?
A
A probable sign of pregnancy of irregular contractions.
20
Q
What hormone indicates a positive pregnancy test?
A
Human chorionic gonadotropin (HCG) indicates a positive pregnancy test (which is a probable sign of pregnancy).
HCG can be detected in urine in as early as 8 days after conception.
21
Q
What is a positive sign of pregnancy?
A
- fetal heart rate is detected by doppler and fetoscope
- HCP can feel the fetus move on palpation
- fetus is seen on ultrasound
22
Q
What is the fundal height?
A
A measurement from the top of the fundus to the symphysis pubis as measured in centimeters.
It estimates the gestational age.
23
Q
Complete the sentence:
After week 18, the fundal height in centimeters = number of ______ pregnant.
A
After week 18, the fundal height in centimeters = number of weeks pregnant.
24
Q
The fundal height and gestational age of fetus can be off by how many centimeters?
A
Fundal height and gestational age can be off by plus or minus 2 centimeters.
Ex: a fundal height of 20 cm can indicate that the fetus is somewhere between 18 and 22 weeks old.
25
What are the **physical and psychological changes** in pregnancy caused by?
Changes are caused by **hormones**.
26
What **cardiovascular changes** does a pregnant woman go through?
* lower than normal hemoglobin and hematocrit
* heart rate increases
* blood pressure changes
## Footnote
*Changes are due to increased blood volume.*
27
What hemoglobin and hematocrit levels is considered **anemia** in a pregnant client?
Hematocrit **\< 30%** and Hemoglobin **\< 10** is considered anemia in a pregnant client.
## Footnote
*Pregnant clients have a slightly lower hemoglobin and hematocrit due to increased fluid volume.*
28
How **high** does the heart rate of the pregnant woman increase due to increased blood volume during pregnancy?
A pregnant woman's **heart rate increases 10-15 beats per minute from the baseline**.
## Footnote
*Ex: if the heart rate is normally 60 bpm, it will increase to 70-75 bpm*
29
What are the **blood pressure changes** of a pregnant woman?
* blood pressure ↓ in 1st and 2nd trimester
* *hormonal changes cause vessel dilation*
* blood pressure ↑ in 3rd trimester
* *due to increased blood volume being pumped to fetus*
30
What **interventions** help relieve morning sickness for a pregnant woman?
**Eat crackers and small meals** to help relieve morning sickness.
31
What **urinary changes** occur in a pregnant woman?
* 1st trimester **increased urination** is caused by hormone changes
* 2nd trimester urinary frequency **decreases**
* 3rd trimester **increased urination** is caused by increased pressure of fetus on bladder
32
What is **linea nigra** during pregnancy?
A **dark line** down the middle of the abdomen
33
What is **chloasma** during pregnancy?
Chloasma is the "mask of pregnancy": **brown spots on the face.**
34
What are the typical **psychological changes** that occur to the woman when she finds out she is pregnant?
* ambivalent, excited or scared
* very emotional
35
What is the **recommended weight gain** for a pregnant woman for the entire pregnancy?
**25 - 35 pounds** (11 - 16 kg)
36
What is the recommended **weight gain during the first trimester** of pregnancy?
**3 - 5 pounds (1.4 - 2.3 kg)**
37
What is the recommended **weight gain during the 2nd and 3rd trimesters** of pregnancy?
**1 pound per week (0.5 kg per week)**
38
How many **extra calories per day** are recommended during pregnancy?
An **extra 300 calories** are needed per day while pregnant.
39
How many **extra calories per day are recommended while breastfeeding**?
An **extra 500 calories** are needed per day while breastfeeding.
40
What **vitamin supplements** are commonly prescribed to pregnant clients?
* **folic acid** - to prevent neural tube defects
* **iron** - to prevent anemia due to increased blood plasma
41
# Classification and indication:
**Rho D immune globulin**
* given to Rh-negative moms to prevent blood incompatibility between mom and baby's blood
* given after miscarriage or abortion to prevent Rh antibody formation
* given after birth to mom's that give birth to a Rh-positive baby
42
What vaccinations are **contraindicated during pregnancy** or when planning to become pregnant?
**Do not give measles, mumps, rubella (MMR) and varicella vaccines** during pregnancy or planning to become pregnant.
## Footnote
*Vaccine can harm fetus.*
43
What could **glucose** in the urine of a pregnant client indicate?
Glucose in the urine could indicate **diabetes mellitus.**
44
What does **protein** in the urine of a pregnant client indicate?
Protein in the urine could indicate **infection or pre-eclampsia**.
45
What is a **fetal ultrasound**?
**A picture of the fetus**. It includes information such as:
* gestational age
* breathing
* movements
* tone
* amniotic fluid volume
46
What will the pregnant client need to due to **prepare** for a fetal ultrasound?
**Drink 2 glasses of water one hour before the ultrasound** in order to see the fetus and structures better.
47
What is a **biophysical profile**?
A non-invasive test that **checks the fetus**. It includes:
* ultrasound
* non-stress test
48
What is a **nonstress test**?
A nonstress test is a non-invasive test of the fetus to **check fetal heart rate patterns.**
## Footnote
*The pregnant client lies down with two belts around her waist. One belt measures the fetal heartbeat and the other measures contractions. It takes about 20 minutes.*
49
What is a **reactive** nonstress test?
A **reactive** nonstress test is a **normal** finding and that the fetal heart rate went up normally. It indicates that the fetal heart rate is "reassuring":
* fetal heart rate increases at least **15 beats per minute** over the baseline (between 120 and 160 beats per minute)
* The increase in heart rate lasts at least **15 seconds** within a 20-minute timeframe
50
What is a **NON-reactive** nonstress test?
A **NON**-**reactive** nonstress test is an **abnormal** finding and that the fetal heart rate did not increase enough. It indicates more testing is needed.
*It can also indicate that the fetus was sleeping.*
51
What is an **amniocentesis**?
An amniocentesis tests the amniotic fluid for **genetic disorders and fetal lung maturity.**
*A needle is used to aspirate a small amount of amniotic fluid through the pregnant client's abdomen guided by ultrasound.*
52
What are the **interventions** before and after an amniocentesis?
1. **before procedure -** get informed consent
2. **after procedure** - assess for signs of complications
* bleeding, infection, decreased fetal movement, and cramping
53
What is **quickening** in pregnancy?
Quickening is the moment when the pregnant woman **starts to feel or perceive fetal movements in the uterus**.
## Footnote
*It usually occurs between week 15 and 25. About 50% of women don't feel anything until after 24 weeks gestation.*
54
What is a **kick count test**?
A kick count test is when the pregnant client **counts the number of kicks** by the fetus in a 2-hour period.
## Footnote
*Notify the HCP if there are \< 10 kicks in two consecutive 2-hour periods.*
55
What is a **fern test**?
A fern test identifies the presence of an **amniotic fluid leak.**
## Footnote
*It will make a fernlike pattern on a microscopic slide.*
56
What is a **nitrazine test**?
A nitrazine test identifies the presence of **amniotic fluid** in vaginal secretions by putting a drop of fluid on a paper strip.
## Footnote
*It will turn the paper blue if there is amniotic fluid.*
57
What is a **contraction stress test**?
A contraction stress test is performed at the end of pregnancy to determine how well the **fetus will cope with the contractions** of childbirth.
*Contractions are induced by administering oxytocin and the contractions and heart rate of the fetus is recorded.*
58
# Immediate complication
What is a **positive/abnormal** contraction stress test?
A positive/abnormal result indicates a **bad finding** and that late decelerations of the fetal heart rate were noted.
## Footnote
*Late decelerations are never a good finding.*
59
What is a **negative/normal** contraction stress test?
A normal/negative indicates a **good finding** and that no late decelerations of the fetal heart rate were noted.
60
# Immediate complication
If a client is bleeding from a miscarriage or abortion, how many saturated pads are considered **hemorrhage**?
For miscarriage or abortion, **hemorrhage** is:
* \> 1 saturated pad/hour
* one pad that gets saturated within 15 minutes
61
What are the **insulin needs** for a pregnant client with diabetes mellitus?
During 2nd and 3rd trimester pregnant **client needs more insulin**
## Footnote
*The hormones in the placenta block insulin.*
62
# Describe:
**Disseminated intravascular coagulation** (DIC) during pregnancy
## Footnote
*Immediate complication*
Disseminated intravascular coagulation is a serious **bleeding and clotting complication** in a pregnant client with eclampsia, placenta abruptio, a dead fetus, placenta retention, or infection.
## Footnote
*The clotting factors are becoming over or underactivated.*
63
# Interventions:
**Disseminated intravascular coagulation (DIC)** during pregnancy
* give oxygen
* blood transfusions if bleeding
* heparin if clotting
* monitor kidney function
*B**lood clots can damage vessels in the kidneys.*
64
# Describe:
**Hyperemesis gravidarum**
Hyperemesis gravidarum is when a **pregnant client has severe nausea and vomiting.**
## Footnote
*This puts her at risk of fluid and electrolyte imbalances.*
65
# Interventions:
**Hyperemesis gravidarum**
* give IV fluids
* monitor intake and output
* antiemetics
66
# Describe:
**Endometritis**
Endometritis is an **infection of the lining of the uterus** that may cause peritonitis.
67
# Medications:
**Endometritis**
antibiotics
68
# Describe:
**Fetal utero in death**
Fetal utero in death is **fetal death that occurs at \> 20 weeks gestation.**
## Footnote
*Pregnant client can develop DIC if fetus is left in client for more than 3 weeks.*
69
# Interventions:
**Fetal utero in death**
* appropriate cultural and religious care
* therapeutic communication
* possible touching of baby
* private room
* may be moved off maternity floor or away from any babies
70
# Describe:
**Hepatitis B**
Hepatitis B a **viral infection** that can be transmitted to baby through blood, sputum, vaginal secretions, semen, and breast milk.
71
# Prevention:
**Hepatitis B**
* if pregnant client is positive for Hep B, clean newborn right away
* administer Hep B immune globulin and vaccination
* mom can breastfeed newborn as long as baby got vaccination
72
# Describe:
**HIV and AIDs**
HIV and AIDs is a **viral infection** that can be transmitted to baby through blood, semen, vaginal secretions, or breastmilk.
*Procedures that increase the mixing of blood increases the risk of the baby getting HIV.*
73
# Prevention:
**HIV and AIDs in newborn**
* avoid internal scalp electrodes and episiotomy
* bottle feed if mom is HIV positive
* clean baby well before shots - avoid mixing of blood
* no live vaccines are given to baby (no MMR or varicella)
* antivirals
74
# Describe:
**Gestational hypertension**
Gestational hypertension is **new-onset hypertension during pregnancy** after 20 weeks gestation.
75
# Describe:
**Preeclampsia**
Preeclampsia is **new-onset hypertension after 20 weeks gestation and protein in the urine**.
76
What are the **assessments** for gestational hypertension and preeclampsia?
* assess for headaches
* take blood pressure
* get urine sample to check for proteins
## Footnote
*These are all signs of hypertension.*
77
# Describe:
Eclampsia
## Footnote
*Immediate complication*
Eclampsia is the onset of **seizures** for a pregnant client with preeclampsia.
78
# Describe:
HELLP syndrome
## Footnote
*Immediate complication*
HELLP syndrome is a condition that can cause **severe bleeding** in a pregnant client.
## Footnote
*The cause is not known but associated with gestational hypertension and preeclampsia.*
79
What are the characteristic **signs and symptoms** of HELLP syndrome?
* **H:** Hemolysis
* **EL:** Elevated Liver enzymes
* **LP:** Low Platelets
## Footnote
*All these findings increase the risk of bleeding in a pregnant client.*
80
# Interventions:
**HELLP** syndrome
* possible bedrest
* antihypertensives and magnesium sulfate to prevent eclampsia and pre-eclampsia
81
# Describe:
"TORCH" screening
TORCH screening is screening the pregnant client for **infections that are highly toxic to growing fetus.**
* **T:** Toxoplasmosis
* **O:** Other infections
* **R:** Rubella (German measles)
* **C:** Cytomegalovirus
* **H:** Herpes simplex virus
82
# Teaching:
**Toxoplasmosis**
Avoid raw meat and cleaning out the kitty litter box
## Footnote
*Bacteria is in raw meat and cat feces.*
83
What are the **"Other" infections** for "TORCH"?
* HIV
* syphilis
* parvovirus
* hepatitis B virus
* West Nile virus
## Footnote
*These are all infections that are highly toxic to growing fetus.*
84
# Medications
**TORCH infections**
antivirals or antibiotics
85
# Interventions:
What are the **interventions** for sexually transmitted infections during pregnancy?
* screen pregnant client for infections
* if positive, give antibiotics, antivirals, or antifungals
* have partner tested and treated
86
# Interventions:
Tuberculosis in a pregnant client
* if x-ray is needed, perform after 20 weeks gestation and use lead shield on pregnant client
* TB skin test is safe during pregnancy
* Give antituberculosis drugs during pregnancy
87
# Interventions:
**Tuberculosis** in newborn
* if skin test is positive in newborn, they will get antituberculosis drugs for at least 6 months
* if mom's sputum culture comes back negative, newborn does not need to be isolated from mom
88
# Describe:
Ectopic pregnancy
An ectopic pregnancy is when the **embryo is fertilized outside of the uterus**, usually in the fallopian tube.
89
What are the **characteristic signs and symptoms** of an ectopic pregnancy?
* vaginal spotting that is dark red or brown
* if it ruptures it causes increased pain that radiates to the shoulder
90
# Interventions:
Ectopic pregnancy
1. **give methotrexate**
* to prevent the fetus from developing
2. **prepare for laparotomy** to remove fetus and tube
3. **give rho D immune globulin** (if woman is Rh-negative)
* helps to prevent bleeding
91
What are some **risk factors** for infertility?
* **Woman**
* maternal obesity
* maternal age \> 35
* nutritional deficiencies
* **Man**
* alcohol and drug abuse
* exposure of testes to heat (sauna use)
* endocrine disorders that decrease testosterone
92
What are **kegel exercises**?
Kegel exercises are for **strengthening the pelvic floor muscles in preparation for birth**. They can also help prevent incontinence later in the pregnancy and postpartum life.
## Footnote
*A kegel exercise is like pretending you have to urinate and then holding it. (Men can do them also to strengthen the muscles for bladder control and sexual function).*
