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The Prenatal Journey Flashcards

(84 cards)

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1
Q

Family Assessment

A

roles/relationships
traditional nuclear families
single head of household
the “skip” generation

bowens family systems theory

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2
Q

Primary Prevention (Health Promotion)

A

disease prevention
healthy habits
vaccines

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3
Q

Secondary Prevention (Early Detection)

A

pap smear
mammogram
pelvic exam

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4
Q

Tertiary Prevention (Health Restoration)

A

inpatient/outpatient
doula postpartum home care

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5
Q

Common Gynecological Problems (Adolescents)

A

menstrual irregularities
pregnancy
STIs

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6
Q

Health Promotion Behaviors (Adolescents)

A

exercise/meds
support system/role models
contraception/sex education

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7
Q

Common Gynecological Problems (YA)

A

fertility
endometriosis/vaginitis
contraception/family planning

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8
Q

Health Promotion Behaviors (YA)

A

pre-conceptual education
GYN evaluation
contraception

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9
Q

Minimal Intervention Contraception

A

abstinence (71-75% effectiveness)
fertility awareness (FAM) (71-75% effectiveness)
lactational amenorrhea method (LAM) (98% effectiveness)

no tools needed; easy to start and stop

planning/calculations, high failure rate, limited time of use

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10
Q

Barrier Methods

A

condoms
diaphragm/cervical cap
sponge

80-85% effectiveness

no meds, easy to start and stop

fitting required, messy, require planning, and high failure rate

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11
Q

Hormonal Methods-Combination

A

daily pills
weekly patch
monthly ring

95% effectiveness

cycle control, treatment for GYN disorders, easy to start and stop

SE/weight gain/mood, CI/smokers (estrogen)

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12
Q

Hormonal Methods-Progestin Only

A

POP (mini pill) daily
injection (depo) every 3 months
implant (nexplanon) every 3 yrs

92-99% effectiveness

no estrogen SE, fewer CI, longer coverage (injection/implant)

unpredictable bleeding, precise use required (POP), delay in fertility return after use (depo), requires placement/removal procedure (nexplanon)

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13
Q

IUDs

A

progestin (Mirena) every 3-5 yrs
non-progestin (paragard) every 10 yrs

98-99% effectiveness

longer coverage, minimal bleeding (progestin), normal menstrual cycles (non-progestin)

requires placement/removal procedure, SE/weight gain/mood, risks/perforation, irregular menses (progestin), heavy/painful menses (non-progestin)

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14
Q

Permanent Contraception

A

bilateral tubal ligation (BTL)
vasectomy

96-99% effectiveness

definitive procedure, no hormonal SE

requires placement procedure/surgery, complications/SE/bleeding

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15
Q

Clinical Termination of Pregnancy

A

performed to deliberately end a pregnancy before fetus reaches a viable age

mifeprex/methotrexate; usually done <9 weeks

vacuum aspiration; usually done <12 weeks

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16
Q

Pregnancy Planning

A

average time of conception is 6 months (considered infertility with active cycle monitoring for 1 yr+)
lifestyle behaviors
med eval
prenatal vitamins with folic acid
genetic factors
cycle/ovulation monitoring
timed intercourse

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17
Q

Fertility

A

ovulation, anatomy/uterus (female)/azoospermia (male)

IVF
IUI (intrauterine insemination)

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18
Q

PRESUME

A

Period absent (amenorrhea)
Really tired (fatigue)
Enlarged breasts
Sore breasts
Urination increased
Movement of fetus in uterus (quickening or fluttery sensation in lower abdomen; 20th weeks in first time moms, maybe a little earlier in 2nd time moms)
Emesis and nausea

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19
Q

PROBABLE

A

Positive pregnancy test
Returning of fetus against fingers when uterus is pushed during palpation (“external ballottement”)
Outline of fetus can be palpated
Braxton Hicks contraction (false labor!)
A softening of the cervix (Goodells sign)
Bluish color to vulva, cervix and vagina (Chadwicks sign)
Lower uterine segment becomes soft (Hegars sign)
Enlarged uterus

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20
Q

Human Chorionic Gonadotropin (hCG)

A

earliest biochemical marker of pregnancy

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21
Q

FETUS

A

Fetal movements felt by provider
Electronic device detects fetal heart sounds (doppler)
The delivery of baby
US detects fetus
See visible movement of baby by provider

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22
Q

Nageles Rule

A

first day of LMP
subtract 3 months
add 7 days (edit yr; go forward a year if due date passes december 31)

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23
Q

Fertilization

A

cellular multiplication

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24
Q

Pre-Embryonic Period

A

first 2 weeks after conception

rapid cellular multiplication and differentiation

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25
Embryonic Period
from 3rd week after fertilization through end of 8th week fetus at 8 weeks
26
Yolk Sac
develops 8-9 days after conception essential for transfer of nutrients during 2nd and 3rd weeks of gestation hematopoiesis until week 8 when fetal liver takes over atrophies and is incorporated into umbilical cord
27
Placenta
takes over at 12 weeks!
28
Circulation
heart begins to beat and circulate blood by end of 3rd week; visible on US by week 6 **umbilical vein: oxygenated blood from *placenta* to *fetus*** **umbilical artery: removed waste, deoxygenated blood from *fetus* to *placenta***
29
Placental Formation
develops from trophoblastic cells and is well established by 8-10 weeks and fully functional at 12 weeks protects fetus and provides oxygenation, nutrition, waste elimination and hormones
30
Amniotic Membranes (Placenta)
early protective structures 2 separate membranes *amnion: inner membrane* *chorion: outer membrane* slightly adherent; forms amniotic sac
31
Amniotic Fluids (Placenta)
fetal urine and lung secretions primary contributors (late gestation; mostly water before 20 weeks) slightly alkaline contains antibacterial, other protective substances
32
Umbilical Cord
usual location is in center of placenta approx. 55 cm (21 in.) long; 1-2 cm diameter **1 vein, 2 arteries** *whartons jelly: protects umbilical cord from compression!*
33
First Trimester (Conception to 12 Weeks)
transforms from embryo to fetus by week 8 organogenesis complete by week 9 heartbeat by doppler by week 10 face with recognizable features by week 10 **estimated: length 5-6in and weight of 2 oz by week 12**
34
Second Trimester (13 to 27 Weeks)
a time of rapid growth and organ refinement lanugo is present by week 20; quickening by week 20 fetal respiratory movements and surfactant production by week 24 **estimated: length 14-15 in. and width of 2lb-12oz by week 28**
35
Third Trimester (28 to 40 Weeks)
eyes are open by week 28 rapid brain development complete by week 32 full lung maturity by week 36 complete subq fat deposition by week 38 **estimated: length 19-21 in and weight of 7-8 lbs**
36
Before Conception Pituitary Hormones
affects ovarian follicular development prompts ovulation stimulates uterine lining
37
After Conception Ovarian Hormones
maintains endometrium aids in implantation decrease uterine contractility initiates breast ductal system development
38
Hormonal Changes Before 12 Weeks
HCG from fertilized ovum stimulates corpus luteum to make estrogen and progesterone
39
Hormonal Changes After 12 Weeks
placenta takes over in production of estrogen and progesterone
40
Uterine Changes
increased vascularity dilation of blood vessels hyperplasia and hypertrophy development of decidua (*thick uterine membrane lining*)
41
Cervical Changes
chadwick’s sign (*violet blue color of mucosa and cervix; increased vascularity*) leukorrhea/white discharge (*increased mucous production; formation of mucous plug*) hagers sign (*softening of lower uterine segment*) goodells sign (*softening of cervical tip*)
42
Vaginal/Vulvar Changes
vaginal preparation for eventual birth (*thicker mucosa, looser connective tissue, hypertrophy of muscles, lengthening of vaginal vault*) acidic vaginal environment (**increased lactic acid, protects from some organisms, more susceptible to yeast infections**) increased vascularity and sensitivity (*increased sexual interest, especially in 2nd trimester*)
43
Breast Changes
fullness heaviness vessel dilation heightened sensitivity areolae more pigmented montgomerys tubercles (*glands that appear as small bumps on areola*) colostrum
44
Integumentary Changes
chloasma (can be permanent) linea nigra (can resolve in 1 yr) striae gravidarum (permanent but fade) palmar erythema (*constant itchiness/redness of palms*)
45
Neurological Changes
decreased attention span/concentration/memory HA carpal tunnel syndrome sciatica syncope
46
MSK Changes
lordosis diastasis recti abdominis
47
CV Changes
BP (supine hypotension) stasis of blood in LE; **risk for varicose veins and venous thrombosis** increased plasma (up to 50%) physiologic anemia and increased need for iron; **greatest risk of anemia at 32-34 weeks** cardiac hypertrophy increase HR/palpitations systolic murmurs
48
Respiratory Changes
increased O2 consumption elevated diaphragm (less room!) increased chest circumference and dyspnea nasal stuffiness/congestion increased mucous production epistaxis
49
Renal Changes
increased estrogen and progesterone; increased blood flow; pressure from enlarging uterus; ENLARGED RENAL PELVIS
50
Upper GI Changes
n/v in early pregnancy (hCG) pica gums bleed easily difficulty swallowing due to relaxation of smooth muscle heartburn/reflux
51
Lower GI Changes
abd discomfort distention cramping constipation/flatulence round ligament pain pelvic pressure
52
The First OB Interview Q’s
current pregnancy OBGYN history review of systems med history nutrition history history of drug use and herbal medicine family history social, experiential and occupational history history of abuse
53
Gravida
total # of pregnancies the pt has had
54
Para
total # of pregnancies > 20/24 weeks
55
Nulligravida
never been pregnant
56
Primigravida
pregnant for first time
57
Multigravida
Pregnant more than once
58
Nullipara
never completed pregnancy beyond 20 weeks due to never being pregnant OR abortions
59
Term
# of pregnancies carried to term (37+ weeks)
60
Preterm
# of pregnancies between 20-36/7 weeks and
61
Abortion
# of losses before 20 weeks
62
First Trimester Visit Frequency
weeks 4-8: initial visit weeks 8-12: every 4 weeks
63
Second Trimester Visit Frequency
every 4 weeks
64
Third Trimester Visit Frequency
weeks 28-36: every 2 weeks week 36-birth: every week
65
Nutritional Health Promotion
calories: increase of 300 a day protein: only slight increase needed (1-2 servings/day) **seafood warning!!!** 8-10 8 oz glasses of water a day iron: 27 mg/day folic acid/folate: 800 mcg/day minimum Ca: 1300mg/day
66
Weight Gain
appropriateness of pre-pregnancy BMI is major determinant of recommended weight gain underweight: 28-40 lbs normal (18.5-24.9): 25-35 lbs overweight (25-29.9): 12-25 lbs obese: 11-20 lbs
67
Exercise
low-impact, no-contact and lots of rest
68
First Semester Screening Tests
DNA testing dating US H&H blood type/Rh antibody syphilis test (RPR) rubella hep B HIV
69
First Trimester Diagnostic Test
CVS
70
Second Trimester Screening Tests
MSQS anatomy scan (US)
71
Second Trimester Diagnostic Test
amniocentesis
72
Third Trimester Screening Tests
fetal kick counts GTT GBS H&H blood type/Rh antibody syphilis test (RPR)
73
Third Trimester Advanced Fetal Assessment
US/growth NST/BPP doppler studies
74
First Trimester Chromosomal Abnormalities (Non-Routine Screening)
free fetal cell DNA maternal serological testing (*can be done as early as 10 weeks, cfDNA fragments of both pregnant person and fetus circulate in blood, **ID’s trisomy 13,18 and 21***) for high risk pts! **-maternal age >35** **-hx of chromosomal abnormalities** **-suggestive results from US** **-pos. results from other serum tests** **commonly performed if abnormal quad screen in 2nd trimester**
75
First Trimester Chromosomal Abnormalities (Non-Routine Diagnostics)
chorionic villus sampling (*1st trimester 10-13 weeks; transabdominal or trans-cervical, genetic studies, doesn’t test for NTDS*) **very invasive and only done if absolutely necessary**
76
First Trimester Chromosomal Abnormalities (Routine Screening)
nuchal translucency by US (11-14 weeks) (*measurement >3 mm have an increased risk of trisomy 13,18,21; PAPP-A/BHcg testing increases accuracy of NT testing; **doesn’t test for NTD and will still need AFP testing***)
77
Second Trimester Chromosomal Abnormalities (Routine Screening)
maternal serum quadruple screening (MSQS): serology looking at maternal hormonal lvls (**estradiol, inhibin-A, hCG, AFP**) a calculated risk assessment for aneuploidy (trisomy 13,18,21) and neural tube defects (high sensitivity/low specificity) **a pos. AFP test isn’t diagnostic and requires further follow up; if high, possible NTDs; if low, possible trisomy 18 or 21** valid results from 15-22 weeks normally not used in multiple pregnancies
78
Second Trimester Chromosomal Abnormalities (Non-Routine Diagnostics)
amniocentesis (15 weeks+) detects trisomy 13,18,21 and open neural tube defects hemolytic disease **very invasive!**
79
Third Trimester Gestational Diabetes Screening (OGTT) (Routine Screening)
1-hr OGTT (*non-fasting; 50 gm glucose bolus; <130-140mg/dL NO GDM, > means yes*) 3-hr OGTT if failed 1 hr (*fasting; 100 gm bolus, FBS, 1hr, 2hr and 3hr; 2 values above designated thresholds indicate GDM*)
80
Third Trimester GBS Routine Screening (36-37 Weeks)
insert swab 2cm into vagina; don’t touch cotton end with fingers insert SAME swab 1 cm into anus remove cap from sterile tube place swab into tube make sure swab container is fully labeled and place into transport bag
81
Third Trimester Advanced Fetal Assessment for High Risk Pts
NST/BPP/Doppler studies (1+ combo of tests may be used) begin additional surveillance 32 weeks until delivery depending on maternal history and current condition testing frequency is also condition dependent
82
Reactive Non-Stress Test (NST)
2+ FHR accelerations of 15 BPM lasting 15 seconds, occurring within a 20 min time frame reassuring!!
83
BPP (>32 Weeks)
EFM and US to evaluate fetal well being scoring system of 0-10; results read 10/10 **BPP <6 need further action** (delivery? gestational age?)
84
Doppler Studies
a measure of velocity of blood flow in umbilical artery decreased, absent and reverse flow indicates worsening placental insufficiency intrauterine growth restriction (IUGR)

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