TEST 1 Flashcards
(193 cards)
1
Q
Fertilization
A
Fusing of ovum and sperm
*Starting point of pregnancy //typically occurs around 2 weeks after last normal menstrual period in 28-day cycle
2
Q
How many sperm are contained in ejaculated semen?
A
200 mil/ML
3
Q
Zona Pellucida
A
Clear protein layer blocks sperm
Disappears in about 5 days
4
Q
Sex determination is determined when and how
A
at fertilization and on whether the ovum is fertilized by Y bearing sperm or X bearing sperm.
5
Q
XX zygote becomes?
XY zygote becomes?
A
XX - Female
XY - Male
6
Q
Ectoderm forms?
A
Central nervous system, special senses, skin and glands
7
Q
Mesoderm forms
A
Skeletal, urinary, circulatory, and reproductive organs
8
Q
The endoderm forms?
A
Respiratory system, liver, pancreas and digestive system
9
Q
Where does fertilization take place?
A
In ampulla of fallopian tube
10
Q
Union of sperm and ovum forms?
A
zygote (46 chromosomes)
11
Q
Cleavage cell division continues to form a
A
Morula (mass of 16 cells)
12
Q
The inner cell mass is called?
Which forms?
A
Blastocyst
Forms embryo and amnion
13
Q
The outer cell mass is called?
which forms?
A
Trophoblast
Placenta and chorion
14
Q
Implantation occurs –how many days>? and where
A
7-10 days after conception in endometrium
15
Q
When do the embryonic membranes begin to form?
A
around time of implantation
16
Q
What does the chorion consist of?
A
Trophoblast cells and mesodermal lining
17
Q
Chorionic villi?
A
Finger like projections from chorion
18
Q
What does the amnion originate from?
What is amnion?
Expands until?
A
-Ectoderm germ layer
-It is a thin protective membrane that contains amniotic fluid.
-It expands until it touches the chorion (outer layer)
*These two layers form fluid filled amniotic sac
19
Q
How much amniotic fluid is there at term?
A
approx 1 L
20
Q
Where is amniotic fluid derived from?
A
Fluid transported from maternal blood across the amnion and fetal urine
21
Q
What does amniotic fluid do?
A
-Help maintain consistent body temp
-Permit symmetric growth and development, -Cushion the fetus from trauma
-Allow umbilical cord to be free from compression
-Promote fetal movement to enhance musculoskeletal development.
22
Q
Amniotic fluid is composed of ?
Alkaline or acidic?
Contains?
A
98% water, 2% organic matter
-Slightly alkaline
-Contains albumin, urea, bile, renin, glucose, hormones, uric acid, creatinine, bilirubin, lecithin, sphingomyelin, epithelial cells, vernix and fine hair.
23
Q
Oligohydramnios
A
Too little amniotic fluid <500 mL at term
24
Q
What is oligohydramnios associated with
A
uteroplacental insufficiency, fetal renal abnormalities, and higher risk of surgical births and low birth weight
25
Hydramnios
too much amniotic fluid
(>2000mL at term)
26
What is hydramnios associated with
maternal diabetes, neural tube defects, chromosomal deviations and malformations of CNS and/or GI tract that prevent normal swallowing of amniotic fluid by fetus
**threaten premature rupture of membranes due to uterine over distention
27
Umbilical cord is formed from
amnion
28
Umbilical cord contains how many veins and arteries?
1 large vein
2 small arteries
29
Wharton jelly?
Specialized connective tissue
SUrrounds 3 blood vessels in umbilical cord to prevent compression
30
Umbilical cord reaches max length at?
Avg cord is how long
30 weeks
22 inches long, 1 inch wide
31
What are the precurser cells of placenta?
Trophoblasts
32
What makes hCG and what does it do?
as early as 3 days after conception, the trophoblasts make hCG
hCG hormone ensures the endometrium will be receptive to implanting the embryo.
33
What does the placenta do?
Makes hormones to control basic physiology of the mother so fetus is supplied with nutrients and oxygen
Protects fetus from immune attack
Removes waste products
Induces mother to bring more food
HOrmones to ready fetal organs for life
34
Placenta function depends on
Maternal blood pressure supplying circulation
35
Placental barrier
Fetal tissues that separate maternal blood and fetal blood
Materials are only interchanged through diffusion
36
What delivers nutrients to the placenta?
What carries fetal waste away?
Maternal uterine arteries
Mothers uterine veins carry fetal waste away
37
What week is the structure of the placenta completed?
usually week 12
38
Chorionic gonadotropin (CG)
Preserves the corpus luteum and its progesterone production so that the endometrial lining is maintained.
*The basis for pregnancy test
39
Prolactin
Mediates maternal metabolic adaptations to pregnancy by regulating insulin production and sensitivity; plays an important role in lactation
40
Human placental lactogen (hPL)
modulates fetal and maternal metabolism, participates in the development of maternal breasts for lactation, and decreases maternal insulin sensitivity to increase its availability for fetal nutrition
41
Estrogen (Estriol)
Causes enlargement of a womans breasts, uterus, and external genitalia, stimulates myometrial contractility
42
Progesterone (progestin)
Maintains the endometrium, decreases the contractility of the uterus, stimulates maternal metabolism and breast development, provides nourishment for early conceptus
43
Relaxin
Potent vasodilator and regulates maternal hemodynamics. Acts synergistically with progesterone of the pelvic ligaments, soften cervix in prep for birth
44
Teratogens
Substances that cause birth defects
(alcohol, drugs, infections, radiation, nutritional deficiencies
45
Fetal stage
from 8th week until birth
Longest period of prenatal development
Conceptus is mature enough to be called fetus
46
The lung function is taken over by what during fetal life? and where does fetal circulation oxygenation occur?
Placenta & placenta
47
What 3 shunts are present during fetal life?
Ductus venosus
Ductus arteriosus
Foramen ovale
48
Ductus venosus
Bypasses liver and connects the umbilical vein to inferior vena cava
49
Ductus arteriosus
bypasses the lungs and connects the main pulmonary artery to descending aorta
50
Foramen ovale
bypasses the right ventricle and lungs via an anatomic opening between the right and left atrium
51
What carries oxygenated blood from placenta to fetus?
What carries unoxygenated blood from?
umbilical vein
2 umbilical arteries
52
Genetics
Genomics
Genetics - study of heredity and its variation
Genomics - study of all genes and includes interactions among genes and its environment
53
Amniocentesis and chorionic villus sampling test what
confirm genetic anomaly
54
a fetal nuchal translucency test can suggest
presence of trisomy 21 or down syndrome if nuchal thickness is found
55
Genome
entire hereditary information encoded on DNA
56
Each chromosome is made up of_____
and define
Genes - individual units of heredity of all traits and are organized into long segments of DNA that occupy a specific location on a chromosome to determine a particular characteristic in an organism
57
Genotype
Genotype - specific genetic makeup of an individual, usually in form of DNA
58
Allele
1 of 2 or more alternative versions of a gene at a given position or locus on chromosome
59
Phenotype
the observed or outward characteristics of an individual
60
Homozygous
Heterozygous
Homozygous - same for charaterisitc
Heterozygous - different
61
Humans have how many chromosomes?
How many nonsex or autosomes and how many sex?
46
22 pairs of non sex
1 pair of sex
62
Karyotype
pictorial analysis of the number, form and size of an individuals chromosomes
Ex 46, XX for a female
46 XY for a male
63
Mendelian laws of inheritance
Patterns occur because a single gene is defective and disorders that result are referred to as monogenic or mendelian
64
Monogenic disorders include:
Autosomal dominant
Autosomal recessive
X-linked dominant
X-linked recessive
65
Autosomal dominant inheritance disorder
occur when a single gene in the heterozygous state is capable of producing the phenotype
**mutant gene overshadows normal gene and person will show signs
66
Common types of genetic disorders that follow autosomal dominant pattern of inheritance include
neurofibromatosis, marfan syndrome, hungtington disease, achondroplasis, polycystic kidney disease
67
Autosomal recessive inheritance disorders
occur when 2 copies of the mutant gene in homozygous state are necessary to produce the phenotype
68
Common types of genetic disorders that follow autosomal recessive inheritance include
Cystic fibrosis
phenylketonuria
Tay-sachs disease
Sickle cell disease
69
X-linked inheritance disorders
associated with altered genes present on X chromosome
Male - will express conditon bc they have only one X
Females - have 2 X so either heterozygous or homo
70
X linked recessive inheritance
demonstrated recessive pattern of inheritance
More affected males than females bc all genes on male are X so it will be expressed
Females will need 2 abnormal X to exhibit otherwise are carriers
No male to male transmission // male will have carrier daughters
71
Common types of genetic disorders that follow X linked recessive include
Hemophilia
Color blindness
Duchenne muscular dystrophy
72
X-linked dominant inheritance
Conditions
When a male has abnormal X chromosome or female has 1 abnormal X
**have lethal results in males
Rare
Hypophophatemic rickets and fragile X syndrome
73
Multifactorial inheritance disorders
thought to be caused by multiple gene and environment factors
74
Nontraditional inheritance patterns and examples
Do not follow typical patterns
Mitochondrial inheritance and genomic imprinting
75
Mitochondrial inheritance
Examples
Usually passed from mother to offspring
Often seen in one or more organs - brain, eye and skeletal muscle
Often assoc with energy deficits in cells with high energy requirements such as nerve and muscle cells
Ex. Kearns-Sayre syndrome and lebers hereditary optic neuropathy
76
Genomic imprinting
Phenomenon by which the expression of a gene is determined by its parental origin //both maternal and paternal alleles are present but only 1 is expressed
Ex Prader-willi syndrome, angelman syndrome, beckwith-wiedemann syndrome
77
Chromosomal abnormalities
Do not follow striaghtforward pattern of inheritance
Occur due to random events during formation of reproductive cells
-most occur due to error in egg or sperm
78
Mosaicism
when chromosomal abnormalities do not show up in every cell
Symptoms are usually less severe
79
Abnormalities of chromosome number
due to nondisjunction (failure of separation of chromosome pair during cell division, meiosis or mitosis)
Most result in spontaneous abortion
80
Two common abnormalities of chromosome number are
Monosomies
Trisomies
Monosomies - only 1 copy of a particular chromosome instead of a pair
*surivial only seen in mosaic forms
Trisomies - 3 of a chromosome (down syndrome, trisomy 18 and 13)
81
Abnormalities of Chromosome structure
Occur when there is a breakage and loss of portion of one or more chromosomes and during repair the broken ends are rejoined incorrectly
82
Examples of structural rearrangements that can be balanced
Inversions - turned upside down
Translocation - portion transferred to another chromosome
Ring - form a ring
83
Sex chromosome abnormalities
Affect sexual development, may cause infertility, growth abnormalities, possibily behavioral and learning problems
Tuner syndrome in females
Klinefelter syndrome in males
84
One spermatogonium gives rise to how many spermatozoa?
4
85
Morula
"little mulberry"
solid ball of cells after 4 cleavages of a zygote
Fluid enters morula and a blastocyst is formed
86
Meiosis
reduces the number of chromosomes in the parent cell by half and produces four gamete cells
87
Mitosis
a type of cell division that results in two daughter cells each having the same number and kind of chromosomes as the parent nucleus, typical of ordinary tissue growth.
88
What categories of signs and symptoms have pregnancy been grouped into
Presumptive
Probable
Positive
89
What are presumptive signs of preg?
**Signs that the mother can perceive**
Ex. absent of menstruation, nausea, fatique, breast tenderness, urinary freq,
*least reliable indicators bc they can be caused by other conditions
90
What are probable signs of pregnancy
* Those that can be detected on physical examination by health care provider
* Softening of lower uterine segment or isthmus, softening of cervix, bluish purple coloration of vaginal mucosa and cervix, changes in shape of uterus, abdominal enlargement, braxton hicks, ballottement
**pregnancy test considered a probable sign
91
What is the hormone detected in pregnancy tests?
Levels considered negative and positive?
Human chorionic gonadotropin (hCG) - bioprotien and earliest marker
**lower than 5mIU/ML** = negative
**higher than 25 mIU/ML** = positive
92
What are low levels of hCG associated with?
Higher levels?
**Lower** - ectopic pregnancy
**Higher** - molar preg & multiple gestational pregnancies
93
What are striae gravidarum?
* Stretch marks
* Irregular reddish streak that appear on abdomen, breast and butt
* Estrogen, relaxin and adrenocorticoid contribute to these changes
94
Why are Iron and Folic acid needed to be supplemented in pregnancy?
Recommended amount?
* Increased requirements too great for food alone
* Needed to form new blood cells for expanded maternal blood volume and to prevent anemia. Iron is essential for fetal growth and brain development. Prevent neural tube defects
* 27mg of ferrous iron and 400-800mcg of folic acid per day
95
The current DRI suggest to increase a pregnant womans intake of
Protein
Iron
Folic acid
calories
**Protein** - from 60-80g/day
**Iron** - from 18-27g/day
**Folic acid** - 400 to 800 mcg/day
**calories** - increase by 300 for a 1800-2200 cal amount
96
FDA and EPA suggest pregnant woman and nursing mothers to avoid?
* -FIsh with moderate to high mercury
* SHark, swordfish, king mackerel, orange roughy, ahi tuna, and tilefish
* Eat up to 12oz of weekly fish with low mercury (shrimp, canned tuna, salmon, lobster, sole, tilapia, cod, haddock, pollock and catfish)
* Check local advisory about safety of fish caught by family and friends
97
Where is listeria commonly found? what foods
Processed and prepared foods, raw or unpasteurized milk
98
What are the pregnancy weight recommendations based on BMI?
**Underweight (BMI less than 18.5)** = 28-40lb
**Normal weight (BMI 18.5-24.9) **25-35lbs
**Overweight (BMI 25-29.9) **15-25lbs
**Obese (BMI 30 or higher)** 11-20lbs
99
For women who are in the normal weight limits how much should they gain each trimester?
**1st** - 3.5-5
**2&3** - 1lb per week
100
For women who are under or overweight how much weight should they gain each trimesters
**1st** - *underweight* =5lb. *overweight* 2lb
**2&3** - *underweight* = slightly more than 1lb/wk
*overweight* - 2/3lb/week
101
If a woman is lactose intolerant how can she get additional sources of calcium?
peanuts, almonds, sunflower, broccoli, salmon, kale and molasses
102
If a woman is vegetarian how can she increase her
Protein
Iron
Calcium
Vit B12
**Protein** - Soy foods, beans, lentils, nuts, grains and seeds
**Iron** - variety of meat alternatives along with vit c rich foods
**Calcium** - soy, calcium fortified orange juice, soy
**Vit** **B12** - soy and b12 supplement
103
Pica
Describe intense craving for and eating nonfood items over a period of time of atleast 1 month
More common un US and afraican america
Ex. dirt, clay, laundry starch, burnt matches, stones, charcoal, ice
104
What does consuming the following do to nutritional
Soil
Clay
Ice
Laundry starch
**Soil** - causes iron deficiency anemia
**Clay**- constipation, can contain toxic substance and cause parasitic infection
**Ice** - cause iron deficiency anemia, tooth fractures, freezer burn
**Laundry starch**- leads to iron deficiency, replaces protein metabolism = depriving fetus of amino acids needed for proper development
105
The success of pregnancy depends on what 5 things
1. fertilization and implantation
2. development and function of placenta
3. Adaptation of maternal physiology to accept fetus and supply its nutritional, metabolic and physical demands
4. Approp growth and development of organs and homeostatic systems in fetus
5. Proper timing of birth so fetus can survive outside
106
Hegar sign
demonstrated as a softening in the consistency of the uterus, in the lower segment or isthmus
107
Goodell sign
Softening of cervix
6-8 weeks
due to vasocongestion and estrogen
108
Chadwick sign
bluish-violet discolouration of the mucous membranes of the vulva, vagina (particularly on the anterior vaginal wall), and the cervix
due to vascularization
109
Ballottement
med a technique of feeling for a movable object in the body, esp confirmation of pregnancy by feeling the rebound of the fetus following a quick digital tap on the wall of the uterus
110
What other conditions can change uterine shape?
Tumors, polyps, infection, pelvic congestion
111
WHat is cervical ripening and when does it happen
softening, effacement and increased distensibility
4 weeks before birth
112
Leukorrhea
increased vag discharge that is acidic, white, thick
*normal excpt w/ itching & irritation = candida albicans & can be transmitted to neonates who then develop thrush
113
Why does ovulation cease during pregnancy
bc of elevated estrogen and progesterone which block FSH and LH
114
What hormones affect breasts in pregnancy
What is purpose of sebaceous glands in breasts
Estrogen & progesterone
To keep nipples lubricated
115
Ptyalism
excessive salivation
Caused by decrease in unconscious swallowing
116
why is the risk of gallstone formation increased in preg
emptying of gallbladder is prolonged due to smooth muscle relaxation from progesterone. Hypercholesterolemia can follow increasing gallstone formation
Laproscopic cholecystectomy is safe in all trimesters
117
What is the med used to treat morning sickness
Doxylamine succinate 10mg/pyridoxine hydrochloride 10mg (Diclegis)
2tab at bedtime
118
Physiologic anemia of pregnancy
dilution of RBCs
Reflected in lower hematocrit and hemoglobin
119
What can increase slow venous return, pooling and dependent edema?
as well as venous thrombosis
Increased fibrin and plasma fibrinogen along with various clotting factors coupled with venous statis secondary to venous pooling
Occurs in late pregnany after long periods of standing
120
What can cause congestion, nosebleed, rhinitis in pregnancy
Increased vascularity of respiratory tract, rising levels of sex hormone, heightened levels of sensitivity to allergens
121
Dilation of kidneys and ureters can increase potential for
urinary stasis and infection
122
Will pregnant women need higher or lower doses of drugs?
drugs excreted thorugh kidneys might require higher doses and more freq doese to maintain therapeutic levels
123
Why is maternal thyroid hormone important to fetus
critical for fetal brain development, neurogensis and organizational processes prior to 20 weeks when fetal thyroid production is low
124
What inhibits direct influence of prolactin on breasts?
Progesterone
125
What is one of the key changes in adrenal glands during pregnancy and what does it do
increase in cortisol
regulates carb and protein metabolism & helpful in times of stress
*cortisol increases in response to increased estrogen
126
What are 4 things cortisol does in pregnancy
1. helps keep up level of glucose in plasma by breaking down noncarb sources
2. breaks down proteins to repair tissues and make enzymes
3. antiinsulin, antiinflam, antiallergic actions
4. Needed to make precursor of adrenaline
127
Growth hormone does what
Promote protein synthesis
128
What is the purpose of prolactin
promote breast develop and lactation
*secreted in pulses and increases 10 fold
129
Melanocyte stimulating hormone (MSH)
Creates skin changes along with estrogen
130
What is oxytocin responsible for
uterine contractions
bringing about delivery
Milk ejection
Contraction of myoepitheilia cells in mammary gland
131
Role of vasopressin AKA ADH in pregnancy
inhibit formation of urine via vasoconstriction to increase BP to regulate water balance
132
What is the period of greatest environmental sensitivity and consequent risk for the developing embryo
17 - 56 days after conception
133
What is a reproductive life plan
individualized life plan of reproduction with goals based on personal beliefs and values
134
What is the focus of the prenatal care
to reduce the risk of adverse health effects for woman, fetus and newborn by addressing modifiable risk factors and providing education about a healthy pregnancy
135
What are the 2 methods prenatal care can be delivered
individually
in a group called "centering"
136
Uncontrolled diabetes in pregnancy increases the risk of
Spontaneous abortion
Fetal anomalies
pre-eclampsia
fetal demise
Macrosomia
Neonatal hypoglycemia
hyperbilirubinemia
137
What are the target blood sugar levels for woman with diabetes
Fasting: Lower than 95
1hour postprandial: lower than 140
2 hour postprandial: lower than 120
138
What is Nageles rule
1. use first day of last normal menstrual period
2. Subtract 3 from the number of months
3. Add 7 to the number of days
4. Adjust the year by adding 1
5. Estimated due date =
139
Gravid
The state of being pregnant
140
Gravida/Gravidity
The total number of times a woman has been pregnant, regardless of birth or multiples
141
Nullgravida
A woman who has never expierenced pregnancy
142
143
Primigravida
A woman pregnant for the first time
144
144
Secundigravida
A woman pregnant for the 2nd time
145
Multigravida
a woman pregnant for at least the 3rd time
146
Para
The number of times the woman has given birth to a fetus of at least 20 wks (viable or not) counting multiples as 1
147
Parity
of pregnancies carried to the point of viability (not number of fetuses)
148
Nullipara (Para 0)
A woman who has not produced a viable offspring
149
Primipara
a woman who has given birth once after a pregnancy of at least 20 wks
aka "Primp"
150
Multipara
A woman who has had 2 or more pregnancies of at least 20 wks resulting in viable offspring
"Miltip"
151
GTPAL or TPAL?
**G** - **Gravida** (current preg to be included in count)
**T - Term births** (Delivered between 38-42wks)
**P - Preterm birth** (ending before 20wks or viability but before 37wks)
**A - abortions **(before 20wks)
**L - Living children**
151
152
High levels of estrogen during preg place women at a higher risk of
DVT
153
What 3 measurements are assessed for pelvis
1. Diagonal conjugate
2. True conjugate
3. ischial tuberosity
154
What is the diagonal conjugate?
What do measurements represent?
Distance between anterior surface of sacral prominence and anterior surface of inferior margin of symphysis pubis
12.5cm or greater represented the anteroposterior diameter of the pelvic inlet through which the fetal head passes through
| most useful measurement for esta pelvic size because a misfit with the f
155
What is the Ischial tuberosity diameter
transverse diameter of pelvic outlet
Measurement is made outside the pelvis at lowest aspect of ischial tuberosities
*diameter of 10.5 or more is considered adequate for passage of fetal head
156
What is true conjugate aka obstetric conjugate
Measurement from anteriror surface of sacral prominence to posterior surface of inferior margin of symphysis pubis
*estamated by subtracting 1-2cm from diagonal conjugate measurement
**Avg is at least 11.5cm
| Smallest front to back diameter through which the fetal head must pass
157
What is the recommended follow up visit schedule for a healthy pregnant woman?
Every 4 weeks up to 28 weeks
Every 2 weeks from 28-36 weeks
Every week from 37 to birth
158
After the first prenatal visit what is assessed at each subsequent visit?
-Weight and bp compared with baseline
-Urine testing for protien, glucose, ketones and nitrites
-Fundal height measurements
-Assess for quickening
-Assess fetal heart rate (110-160bpm)
159
When is screening for gestational diabetes best done?
Between weeks 24-28
160
What is the process of gestational diabetes testing?
A blood glucose level is obtained using an oral 50g glucose load followed by 1 hour plasma glucose determination.
* if result is more than 140mg/dl further testing such as a 3 hour 100g glucose test is warranted
161
If mother is Rh-negative and her antibody titer is evaluated, what is given if indicated?
and what does the med do?
RhoGAM
PRevent development of antibodies to Rh-positive red cells whenever fetal cells are known to enter maternal circulation
*Also recommended of a prophylaxis at 28 wks and following birth of a Rh-positive baby
162
How do you measure fundal height
Distance in CM with a tape measure from top of pubic bone to top of uterus with client lying on back with knees slightly flexed
*Reflects fetal growth and provides a gross estimate of duration of pregnancy / Should measure approx equal the number of weeks gestation until 36
| Termed McDonald method
163
Between 12-14 weeks where can fundus be palpated?
Above symphysis pubis
164
When does fundus reach level of umbilicus and what does it measure
20wks
20cm
165
What is a normal fetal heart rate?
110-160bpm
166
What are signs of preterm labor?
Contractions every 10 mins and more freq
Change in vag discharge
Pelvic pressure
low dull backache
pelvic cramps
diarrhea
167
Preterm infants can suffer what problems?
intellectual disability
Chronic lung disease
Cerebal palsy
Seizure disorder
Blindness
168
If a woman expierences cramps occuring every 10 mins with a backache what should she do?
Lie down on left side for 1 hour and drink 2-3 glasses of water
if symptoms get worse or do not subside after 1 hour call HCP
169
When can a transvaginal ultrasound not be performed in 1st trimester
ectopic preg
Molar preg
170
A second ultrasound is usually done when?
and looks for?
18-20wks
Looks for congenital malformations, verifies dates and growth
171
A 3rd ultrasound is usually done when and looks for what?
around 34 wks
Eval fetal size, growth and verify placental position
172
What is doppler ultrasonography used for
Uses sound waves to examine flow of blood in vessels
173
What is alpha fetoprotein
Glycoprotein produced initially by yolk sac and fetal gut and alter in fetal liver
*Elevated levels were first linked to fetal neural tube defects
**optimal time for screening is 16-18wks
174
What are some situations that can cause elevated materal serum AFP
Open neural tube defects
underestamation of gestational age
multiple fetuses
Gi defects
low birth weight
oligohydramnios
maternal age
diabetes and decreased maternal weight
175
What are some situations that can cause decreased materal serum AFP
fetal gestational age is overestimated
fetal death
hydatidiform mole
increased maternal weight
Maternal type 1 diabetes
fetal trisomy 21 or 18
176
When are most marked screening tests performed?
Except for free cell fetal DNA which is performed?
15-22wks
9-10wks
177
WHat is the advantage of the cell free fetal DNA test?
detecting trisomy 21 with high sensitivity (99%) and specificity (98%) at an earlier time frame
178
What can alter the levels of MSAFP
A variation of 2 weeks of gestational age
Maternal overweight over 250lb
ethnicity
smoking
fetal gender
gravidity
para status
insulin dependant diabetes
179
What are the risks of amnioentesis
lower abdominal discomfort and cramping, spontaneous abortion, maternal or fetal infection, postamniocentesis chorioamniontsis, fetal-maternal hemorrhage and leakage of amniotic fluid
180
What parameters in the BPP test are controlled by what part of brain?
FEtal tone
FEtal movement
Fetal breathing
Amniotic fluid
**Fetal tone** - cortex
**FEtal movement**- cortex and motor nuceli
**Fetal breathing** - centers close to 4th ventricle, posterior hypothalamus and medulla
**Amniotic fluid**-fetal urine volume
181
What are some personal hygeine recommendations for pregnant woman
-Avoid hottub, sauna, whirlpool, tanning beds = fetal tachycardia
-Use cotton underwear, no douch, panty liners. Avoid perfumed soaps, lotions,etc
-Good dental hygeine. Avoid XRAYs
-150 mins of moderate excerise per week
182
What vaccines are considered during preg
What vaccines are contrindicated
Considered - Hep B, flu, Tdap, rabies
Contraindicated - live flu nasal spray, MMR, Varicella, tuberculosis, thypoid
183
Lamaze Method
Psychopophylacic method of preparing for labor and birth that promotes the use of specific breathing and relaxation techniques
*belived to conqur fear through knowledge and support
Included info on toning excercises, relaxation, breathing methods for labor
184
**Lamaze**
Paced breathing -
Slow paced breathing -
**Paced breathing **- breathing used to decrease stress response and decrease pain. Start by taking a cleansing breath at onset and end of each contraction
**Slow paced breathing **- Assoc with relaxation. 1/2 normal breathing rate (6-9 breaths per min). REcommended thorugh out labor
185
**Lamaze**
Modified paced breathing
Patterned paced breathing
**Modified paced breathing **- to increase altertness. Quite upper chest breath. Inhalation and exhalation are equal
**Patterned paced breathing-** Rhythmic pattern, 4 upper chest breathes followed by exhalation
186
Bradley (partner-coached) method
Uses various exercises and slow controlled abdominal breathing to achieve relaxation
*concentrate on sensations while tuning in to their own bodies.
Coach is trained in massage and comfort techniques
187
Dick-Read method
Believed that the attitude of the woman had toward her birthing process had considerable influence
*fear is primary pain producer
Woman arms herself with knowledge and relaxation
188
AAP recommends breast feeding for how long?
Exclusively for 6 months and continue for a year or as long as desired
189
Infants who are fed formula have an increased risk for what
otitis media
Diabetes
Asthma
Atopic dermatitis
Reflux
Diarrhea
Colic
Constipation
lower respiratory infections
190
what level laceration can a midwife treat?
1st and 2nd
191
How much weight should a person gain in pregnancy
Underweight
Normal
Overweight
Under - 30lbs
Normal - 20
Over - 15lbs
