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Quiz 3 Flashcards

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1
Q

Preterm Birth

A

20 0/7 wk - 36 6/7 wks

decreasing in US @9.5% 2015
highest among AA + hispanic

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2
Q

Spontaneous Preterm Labor

A

unintentional delivery <37wk

Cause: infection or inflammation

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3
Q

Non-Medically indicated

A

C-section/ labor absence of medical need

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4
Q

Medically indicated

A

healthcare provider recommends preterm labor delivery
Cause: preeclampsia

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5
Q

Cervical insufficiency

A

the inability of cervix to retain preg in absence of sign/symptoms of contractions, labor or both in 2nd tri

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6
Q

Multiple Gestation

A

1+ fetus from fertilization of 1 zygote

  • divides or fertilization of 2 ova
    monozygotic twin = 1 egg that divides at 1st week of gestation
    dizygotic = 2 eggs fertilized
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7
Q

Placenta types

A
  1. monochorionic (1 chorion) - 70% monozygotic
  2. dichorionic (2 chorions) - always dizygotic
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8
Q

Twin pregnancy complications

A

Spontaneous delivery
HT + Preeclampsia
gestational diabetes
Antepartum hemorrhage
acute fatty liver
Abruptio placentae

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9
Q

Hyperemesis Gravidarum

A

Severe NV that causes dehydration, electrolyte imbalance + acid/base imbalance, starvation ketosis + weight loss.
-hypokalemia + natremia
- decrease urea

Peaks @ 9-20wks
Cause: increase of HCG, prog, + E, h.pylori, ambivalence towards preg.

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10
Q

Diabetes

A

Presentational - 1/2
Gestational - glucose intolerance (placenta creates HPL that antagonizes insulin, sparing glucose for fetus.)

Type1 : body isnt making insulin - body attacks destroys insulin producing cells
- glucose can’t get into cells + trys to get rid of extra w. kidney
Type 2: body is producing enough insulin but not properly produced overweight can’t stop insulin production. fat deposits on cell can’t open.

Challenge to manage because of
HPL
P
HgH
Corticotropin-releasing hormone

Shift energy source from ketone -> free fatty acid

Treatment:
Euglycemic control
minimize complication
prevent prematurity
-> keep the lowest possible glycosylated hemoglobin w/o going into hypoglycemia

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11
Q

Pregestational Diabetes

A

Blood glucose is elevated but below clinical threshold
Components:
Central adiposity > 35 in
Dyslipidemia
Hyperglycemia
HT

Maternal Risk:
DKA - 2nd tri
HT
Spontaneous Abortion
Polyhydramnios
Induction of Labor
UTI, Hypergly, Postpartum, post hemorrhage
exacerbation of diabetes symptoms

Fetal Risk:
Congenital defect
Prematurity
Hypogly, cal + mag
asphyxia
respir distress
Still birth
hyperbilirubinemia
polycythemia

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12
Q

Gestational Diabetes

A

a hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells. insulin less effective, a condition referred to as insulin resistance

risk:
<25 yr
HT, PCOS
Increase in maternal adiposity
insulin desensitizing hormone
Family history/ age/ race/ obesity history of macrosomia

Diagnosis: glucose testing 24-28 wk

Complications:
Macrosomia
Shoulder dystocia
HT + preeclampsia
preterm birth + stillbirth
C-section

Risks for baby
excessive birth weight
preterm
breathing difficulties
hypoglycemia
obesity + type 2 later in life
stillbirth

Prevention:
maintain healthy lifestyle, keep active, don’t gain more weight than recommended

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13
Q

Preeclampsia

A

Preeclampsia is a kind of high blood pressure some women get after the 20th week of pregnancy or after giving birth. s high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working normally. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy.

  • Leading cause of maternal death
  • 20wks 140/90 @ least 4 hrs apart + proteinuria >300mg or new systemic disease.

High Risk:
>35 yr
AA + low socioeconomic
previous preeclampsia with another preg
pregnant w. multiples
have diabetes + HT, kidney disease, AI
obese
family history of preeclampsia

SS
Headache that doesnt go away
Blurred vision
Epigastric pain
trouble breathing
NV
swelling in face + hands
weight gain - 2-5lbs per week
Proteinuria
Thrombocytopenia
Renal insufficiency
Impair live function
Pulmonary edema
Visual symptoms

Risk for fetus
Morbidity
intolerance of labor
still birth
placenta abruption
IUGR
Low birthweight

Treatment
Early detection
Delivery monitor
Hydra Liz one
Mg sulfate
Oral nifedipine
Labetalol

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14
Q

HELLP syndrome

A

HELLP syndrome is a serious pregnancy complication that affects the blood and liver. HELLP stands for these blood and liver problems:

H–Hemolysis. This is the breakdown of red blood cells. Red blood cells carry oxygen from your lungs to the rest of your body.
EL–Elevated liver enzymes. High levels of these chemicals in your blood can be a sign of liver problems.
LP–Low platelet count. Platelets are little pieces of blood cells that help your blood clot. A low platelet count can lead to serious bleeding.

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15
Q

Eclampsia

A

occurrence of seizure activity in the presence of preeclampsia
- can be ante, intra + post partum

It can be triggered by cerebral vasospasm, hemorrhage, ischemia, edema
Warning:
persistent headaches
epigastric pain
NV
hyperreflexia w. clonus
restlessness

Treatment
Mg sulfate + hypertensive

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16
Q

Placenta Previa

A

1/200
The placenta attaches to the lower uterine segment near/over cervix vs. on the body of the fundus

Risk Factors:
scarring
large placenta
infertility, nonwhite, low socio, short interpreg
diabetes, smoking cocaine use
Painless bleeding

Maternal risk:
Hemorrhagic + hypovolemia shock
Blood loos
Fetal Risk:
Disruption of blood flow
Morbidity + morality

Management:
Avoid vaginal exam
Monitor fetal vitals
Check Amniocentesis + BPP - lung maturity

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17
Q

Placenta Abruption

A

Partial complete detachment of placenta
- hematoma forms + destroys the placenta around it

Grade:
1(mild) least amount of separation
2 (moderate)
3 (Severe) more separation + blood

Risk Factor
decreased placenta perfusion
HT
Seizure
Blunt trauma to the maternal abdomen
history of abruption
smoke/cocaine use

SS
Sudden onset of intense pain
board-like rigidity to the abdomen
uterine irritability
tachystole
vaginal bleeding
port wine stain amniotic fluid

Management
assess fundal height
girth measurement
shock
weigh pads

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18
Q

Placenta Accreta

A

The partial/complete placenta invades and becomes inseparable from the uterine wall.
0 leads to hemorrhage + may need a hysterectomy
- 3000 - 5000 mL blood loss

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19
Q

Abortion

A

Spontaneous or elective termination of pregnancy <20wks

Induced: medical/surgical abortion before fetal viability
Elective: at the request of the woman but not for a medical reason
Therapeutic: abortion because of abnormalities
Spontaneous: nonviable intrauterine preg w. either empty gestational sac or gestational sac containing embryo/fetus w/o heart activity 126/7 wks —> miscarriage

Termination of preg done transcervical by dilation of the cervix, evacuation, fetus out by cuttage, scrapping + vacuum

Meds: mifepristone +misoprostol

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20
Q

Ectopic Pregnancy

A

Fertilized egg grows outside uterus as a result in blastocyst implanting itself other than endometrial lining
- stunted growth + will be nonviable.
- 95% happen in fallopian tube, 5% other ovary, abdominal cavity, cervix
- most are tubual + tube lacks submucosal layer but can’t support the growth of the tropoblast

Risks:
Pelvic inflam disease
infertility
endometriosis
STI
smoking

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21
Q

Gestational Trophoblastic Disease

A

Spectrum of placental-related tumors
- group of rate disease in which abnormal cells grow inside the uterus after conception

MOLAR: hydatidiform mole cili turn into cyst in uterus ~ grape like
NONMOLAR: gestational trophoblastic disease- almost always malignant

SS: Bleeding, NV, HT, no fetal heartbeat +movement

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22
Q

Substance Abuse during Preg

A

Most prevalent in 1-2tri; may be associated w. abnormalities like still birth, fetal growth restriction, neurological development - hyperactivity

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23
Q

Screening for gestational diabetes

A

1 Hr - if over 140 test at 3hrs if positive if they have 2+ criteria (fasting 95mg, 1hr 180 mg, 2hr, 155, 3hr 140). If neg retest at 32 wks

If neg at 1 hr - routine prenatal; care

Glycosylated hemoglobin alc should be less than or equal to 6%

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24
Q

Preg Complications

A

RH Factor
ABO Incompatibility
Ectopic Preg
HSV
GBS
Preeclampsia
Gestational Trophoblastic Disease

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25
Rh Alloimmunization
Rh is inherited protein found on the surface of RBC Rh- doesnt have protein Rh+ has protein Rh- women at risk of having baby w. hemolytic anemia w/o treatment fetus will have jaundice, anemia, brain damage, HF + death Sensitized woman when Rh+ from infant mixes with Rh- mother = creation of Ab Cause: molar preg, ectopic pre, spontaneous abortion, therapeutic, manual removal of placenta, amniocentesis + CVS Tests: indirect coombs (Ab screen), testing father/amnio, early birth, intrauterine transfusion(Correct anemia), exchange transfusion(erythropoietin+ fe) Prevent sensitization give RhoGam at 28 wks + 72 hrs after birth
26
ABO Incompatibility
Mother type O infant A/B Maternal serum Ab cross placenta - hemolysis of fetal RBC - mild anemia -jaundice Not treated antenatally or prophylactic
27
GBS
Group B Strep. In GI/GU Treatment: decrease the bacterial load to limit exposure to fetus
28
Hydatiform Mole
Grape Like Cysts 1. complete: fertilization of empty ovum (no embryonic tissue found) 2. Partial: some fetal tissue; normal ovum but 2 sperm 1/1500birth SS: Rapidly growing uterus, vaginal bleeding, NV.HT. Abnormally high hcg Management: no preg for 1 yr, monitor for malignancy
29
Polyhydraminos
excessive amniotic fluid >2000mL associated with fetal GI anomalies + maternal diabetes Treatment: remove amniotic fluid
30
Oligohydramnios
scanty amniotic fluid <500mL risk: fetal adhesion + malformations Treatment: amniofusion
31
Neonatal assessment
2hrs after birth - general survey, physical assessment, gestational assessment + pain assessment
32
Dubowitz Neurological Exam
assessed 33 responses in 4 areas 1. habituation - response to repetitive light/sound stimuli 2. movement + muscle tone 3. reflexes 4. neurobehavioral items
33
Ballard Maturation
assesses physical + neuromuscular activity + maturity - less time than dubowitz classifies if neonate is avg for gestational weight, lga or sga
34
Periods of reactivity/inactivity
cycle through initial period of reactivity 15-30 mins post birth increased respiration, rapid HR, grunting, flaring Relative inactivity - 30 mins -2hrs infant will sleep Second period of reactivity cycle through active/quiet alert interested in feeding/sucking
35
Brazeiton Neonatal Behavioral Assessment Scale
28 behaviors items, 18 reflex - 6 categories 1. habituation: decrease stim from repetitive stim protects from overstim 2. orientation: the ability to focus on visual auditory stim 3. motor maturity: control/coordinate motor activity 4. self quieting: comforting self 5. social behaviors: response to cuddling 6. sleep wak states - 2 sleep 4 wake
36
Infant Danger Signs
Tachypnea retraction of chest wall grunting/ flaring lethargy abnormal temp hypogly abdominal distension failure to pass meconium in 48 hrs failure to void in 24 hrs convulsions jaundice <24hrs jitteriness cant keep constant temp
37
Ballard Tool
Assessment of physical maturity characteristics - skin transparent friable -1 gelatinous translucent -0 smooth pink visible veins 1 superficial peeling rash few veins 2 cracking pale areas 3 parchment deep cracking 4 leathery cracked wrinked 5 lanugo - diabetic moms have babies w. more hair on back non sparse abundant think bald areas mostly bald Sole smooth sole / small foot >50mm no crease faint red marks anterior transverse cease only creases anterior 2/3 cracked lethary Ear/eye formation lids fused loosely -1 / tightly -2 lids open pinna flat stays folded Slightly curved pinna, soft recoil well curved pinna soft ready recoil formed and firm instant recoil thick cartilage Genitals Smooth flat scrotum/clitoris prominent clit prominent small minora/scrotum empty tests in upper cancl rare rugue/ clitoris prominent, enlarging minora majora + minora equally prominent/testes descending testes down good rugae/ majora large testes pendulous deep rugae/ majora covers clit and minora Breast imperceptible barley flat areola no bud stippled areola raised areola full areola 5-10mm Neuromuscular Posture Square window arm Recoil Popliteal angle scarf sign heal to ear
38
Newborn Vitals
Pulse 110 - 160 bpm (sleep <70) Respiration 30 -60 BP: 70-50mmHg - 90/60 @ day 10 Temp: Ax 97.7-99 skin 96.8 - 97.7 97.8 - 99
39
Caput succedaneum
swelling under the skin of the scalp - fluid filled crosses suture lines
40
Cephalhematoma
collection of blood from broken blood vessels that build up under scalp - doesnt suture line
41
Craniosynostosis
premature closure of suture - restricts growth perpendicular + compensatory overgrowth in unrestricted regions
42
plaglocephaly
develops when an infant's soft skull becomes flattened in one area, due to repeated pressure on one part of the head
43
Milia
white dots on skin
44
Erythema Toxicum
papules on skin last up to 5 days
45
Skin Variations
Vernix Caseosa Forceps marks telangiectatic nevi mongolian spots nevus flammeus stork bites
46
Reflexes
Tonic-neck Moro Grasping Rooting Sucking Babinski Trunk incurvation Protective Blink yawn cough sneeze extrusion reflex
47
Discharge teaching
thermoregulation feeding practices skin/cord care prevention of infection security stool/void patterns safety - car seat sleep position, sids Illness - >100 and <97.7, frequent vomiting refusal of 2x feeding, difficult awakening, breathing difficulties, cyanosis w/wo feeding, inconsolable, no wet diapers for 24 hrs Before discharge Hep B + HBig PKU Hearing screening CHD CDC newborn screen
48
Apgar
HR + Auscultation respiration rate muscle tone relex irritability color Score: o-3 - severe distress 4-6 moderate difficulty 7-10 stable
49
Neonatal period
birth - 28 days need to maintain bodyheat respiration f(x) decrease risk of infection proper hydration + nutrition Proper care
50
First breath
increase aveolar O2 + decreased Aterial pH --> dilation of pulmonary artery -> decrease vascular resistance -> increase blood flor -> increase O2 + Co2 exchange
51
Signs of Respir distress
Cyanosis abnormal resp pattern - tachy + apnea retraction of chest wall grunting flaring hypotonia
52
3 Phases of transition
1. reactivity 1-2 hrs 2. sleep 1-4 3. 2nd period of reactivity 2-8 hrs
53
Circulatory changes
Systemic vascular resistance increase / pulmonary artery pressure - after cord clamp Closure of shunts - foramen ovale, ductus arteriosus, ductus venosus
54
difficult transition
Maternal conditions - diabetes, HT Fetus conditions - congenital anomalies Antepartum - placenta / amniotic fluid Delivery complications Neonatal difficulties - lack of respir effort, blockage, impaired cardiac lung f(x)
55
Hematopoietic adaptations
Blood vol 80-90 ml/kg increase of erythropoietin secreted leukocytosis is normal - increase WBC
56
GI adaptations
small stomach - marble as milk transitions fat increases more enzyme amylase lipase meconium 8-24 hrs weight loss 3-4 day; 3.5% formula, 7% BF
57
Urinary Adaptation
limited capacity to concentration of urine - cant reabsorb water to maintain organ f(x) - void 24 hrs -brick dust stains
58
Hepatic Adaptation
40% of abdomin iron storage regulation of blood glucose-- glycogen -> glucose >40mg coagulation of blood bilirubin conjucation
59
Immunologic Adaptation
passive immunitiy - Ab pass through placenta ; IgG by third tei Active immunity IgA in colostrum
60
Newborn nutrition
Rapid weight gain by 4-6 mo 2x weight 1yr 3x 100-120/kg /day
61
Signs of effective breastfeeding
feeding >8 in 24 hrs swallowing Soft breasts after feeding # of wet diapers increase Stools begin to lighten
62
Baby bottle syndrome
cavities when putting juice/soda in bottle. Hold baby while feeding.
63
Alcohol use
Abnormal brain and neuron development Lbw Premature FAS leading cause of mental retardation
64
Cocaine use
Cardiac maternal events - death Abruption Fetal effects - vasoconstriction neuroexfitation
65
Opioid use
Withdrawal symptoms from neonate
66
Smoking Tobacco
Decreased fertility Increased risk of miscarriage Previa IUGR cognitive impairment
67
Cardinal signs of diabetes
Polyuria Polydipsia Weight loss Polyphagia
68
TD1 what are signs and symptoms of hypoglycemia
Diaphoresis and disorientation
69
Newborn appears LGA while scoring low for neurological maturation what explains that outcome
Maternal diabetes
70
Herpes simplex virus
1/6 infection Fetal risk: Spontaneous abortion Preterm labor IUGR neonatal infection Antiviral therapy after birth - acyclovir
71
Mg sulfate toxicity
Urinary output 20mL/hr Blood pressure 104/62 Respiration of 7 Absent reflex Lethargy Excitability
72
NRP
N: provide warmth clear airway dry stimulate - rapid assessment R; assess breathing p: assess heart rate
73
Evaporation
Cooling of moisture with air
74
Convection
Heat from body is taken away from air
75
Conduction
Heat is transferred to an object that you are touching
76
Radiation
Heat is lost to an object further away
77
Why is surfactant needed
Avelolar stability Decreases surface tension Increases compliance L/S ratio
78
APHAR SCORE
heart rate 0- absent 1 -60-100 2 >100 Respir 0-absent 1- slow irregular weak 2 cry Reflex 0-no response 1-grimace 2-cry Color 0 cyanotic 1pink and blue 2 pink Muscle tone 0flaccis 1some flexion 2active motion

Maternity (4 decks)

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