Week 1 OB Flashcards
(188 cards)
1
Q
The most common genetic disease among people of African ancestry.
A
Sickle-cell anemia (R)
2
Q
Forms rigid crystals that distort and disrupt red blood cells; oxygen-carrying capacity of the blood is diminished
A
Sickle-cell anemia (R)
3
Q
The most common genetic disease among people of European ancestry.
A
Cystic fibrosis (R)
4
Q
Production of thick mucus clogs in the bronchial tree and pancreatic ducts. Most severe effects are chronic respiratory infections and pulmonary failure.
A
Cystic fibrosis (R)
5
Q
The most common genetic disease among people of Jewish ancestry.
A
Tay-Sachs disease (R)
6
Q
Degeneration of neurons and the nervous system results in death by the age of 2 years
A
Tay-Sachs disease (R)
7
Q
Lack of an enzyme to metabolize the amino acid phenylalanine leads to severe mental and physical retardation. These effects may be prevented by the use of a diet (beginning at birth) that limits phenylalanine.
A
Phenylketonuria (PKU) (R)
8
Q
Uncontrollable muscle contractions between the ages of 30 and 50 years, followed by loss of memory and personality. There is no treatment that can delay mental deterioration.
A
Huntington’s disease (Dominant)
9
Q
Lack of factor VIII impairs chemical clotting; may be controlled with factor VIII from donated blood.
A
Hemophilia (X-linked)
10
Q
Replacement of muscle by adipose or scar tissue, with progressive loss of muscle function; often fatal before age 20 years due to involvement of cardiac muscle.
A
Duchenne’s muscular dystrophy (X-linked)
11
Q
Allows for the early detection of genetic disorders such as trisomy 21, hemophilia, and Tay-Sachs disease
A
Prenatal testing
12
Q
The developing human is most vulnerable to the effects of teratogens during the period of _____.
A
organogenesis, the first 8 weeks of gestation
13
Q
Give an example of a teratogen
A
Toxoplasmosis
14
Q
Protozoan parasite found in cat feces and uncooked or rare beef and lamb.
A
Toxoplasma
15
Q
When an en embryo is exposed to ______, fetal demise, mental retardation and blindness can result.
A
Toxoplasma
16
Q
Education for women who are pregnant or attempting to conceived should:
A
- Avoid contact with cat feces, such as cleaning or changing a litter box.
- Avoid eating rare beef or lamb.
17
Q
Exposure to teratogens after 13 weeks of gestation may cause
A
Fetal growth restriction or reduction of organ size
18
Q
Give examples of Drugs and Chemicals (Teratogenic Agents)
A
- Alcohol
- ACE
- Carbamazepine (anticonvulsant)
- Cocaine
- Warfarin (Coumadin)
19
Q
Alcohol - Characteristics of Fetal Alcohol Syndrome (FAS)
A
- low birth weight
- microcephaly
- mental retardation
- unusual facial features due to midfacial hypoplasia
- cardiac defects
20
Q
Increased risk for:
• Renal tubular dysplasia that can lead to renal failure and fetal or neonatal death
• Intrauterine growth restriction
A
Angiotensin-converting enzyme (ACE) inhibitors
21
Q
Increased risk for:
• Neural tubal defects
• Craniofacial defects, including cleft lip and palate
• Intrauterine growth restriction
A
Carbamazepine (anticonvulsant)
22
Q
Increased risk for:
• Heart, limbs, face, gastrointestinal tract, and genitourinary tract defects
• Cerebral infarctions
• Placental abnormalities
A
Cocaine
23
Q
Increased risk for: • Spontaneous abortion • Fetal demise • Fetal or newborn hemorrhage • Central nervous system abnormalities
A
Warfarin (Coumadin)
24
Q
Teratogen examples of Infections/Viruses
A
- Cytomegalovirus
- Herpes varicella (chicken pox)
- Rubella
- Syphilis
- Toxoplasmosis
- Zika
25
```
Increased risk for:
• Hydrocephaly
• Microcephaly
• Cerebral calcification
• Mental retardation
• Hearing loss
```
-Cytomegalovirus
26
Increased risk for:
• Hypoplasia of hands and feet
• Blindness/cataracts
• Mental retardation
-Herpes varicella
27
```
Increased risk for:
• Heart defects
• Deafness and/or blindness
• Mental retardation
• Fetal demise
```
-Rubella
28
Increased risk for:
• Skin, bone, and/or teeth defects
• Fetal demise
-Syphilis
29
Increased risk for:
• Fetal demise
• Blindness
• Mental retardation
-Toxoplasmosis
30
```
Increased risk for:
• Microcephaly
• Blindness
• Hearing defects
• Impaired growth
```
-Zika
31
Where does fertilization occurs?
Fertilization occurs within one of the two fallopian tubes, also called oviducts
32
Site of implantation
Uterus
33
Inner layer of the uterus is called _____.
Endometrium. Each month, estrogen and progesterone stimulate the functional layer to thicken in preparation for egg implantation. If implantation occurs, the endometrium continues to thicken. If implantation does not occur, the functional layer is shed during the menstrual cycle.
34
Menstrual Cycle 2 Phases
1. Ovarian Cycle, 2. Endometrial cycle
35
____ cycle pertains to the maturation of the ova and consists of 3 phases ____, ____, _____
```
Ovarian cycle
(FOS); 1. follicular phase; 2. ovulatory phase; 3. luteal phase
```
36
Phase that begins during the first day of menstruation and lasts 12 to 14 days.
-follicular phase
37
During this phase, the graafian follicle matures under the influence of two pituitary hormones: ____ and ____. The maturing graafian follicle produces what hormone? _____.
- follicular phase
- 2 pituitary hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
- The maturing graafian follicle produces estrogen.
38
This phase begins when estrogen levels peak and ends with the release of the oocyte (egg) from the mature graafian follicle
Ovulatory Phase
39
The release of the oocyte is referred to as _____.
Ovulation
40
LH levels surge 12 to 36 hours before ovulation. Before this surge, estrogen levels decrease and progesterone levels increase.
Ovulatory phase
41
Begins after ovulation and last approximately 14 days.
Luteal Phase
42
During this phase, the cells of the empty follicle morph to form the corpus luteum, which produces high levels of progesterone and low levels of estrogen.
Luteal Phase
43
If pregnancy occurs, the corpus luteum releases progesterone and estrogen until the placenta matures enough to assume this function. If pregnancy does not occur, the corpus luteum degenerates, resulting in a decrease in progesterone and the beginning of menstruation.
Luteal Phase
44
3 Phases of Endometrial Cycle
PSM = 1. Proliferative Phase, 2. Secretory Phase, 3. Menstrual Phase
45
This phase occurs following menstruation and ends with ovulation. During this phase, the endometrium prepares for implantation by becoming thicker and more vascular. These changes are in response to the increasing levels of estrogen produce by the graafian follicle
Proliferative Phase
46
This phase begins after ovulation and ends with the onset of menstruation. In this phase, the endometrium continues to thicken. The primary hormone during this phase is the progesterone secreted from the corpus luteum.
Secretory Phase
47
If pregnancy occurs, the endometrium continues to develop and begins to secrete glycogen, the energy source for the blastocyst during implantation. If pregnancy does not occur, the corpus luteum begins to degrade and the endometrial tissue degenerates.
Secretory Phase
48
This phase occurs in response to hormonal changes and results in the sloughing off and expulsion of the endometrial tissue.
Menstrual phase
49
Conception aka as _____, occurs when a sperm nucleus enters the nucleus
Fertilization
50
Heart begins to beat during ____.
3rd week after conception
51
3 Fetal Circulation
1. ductus venosus, 2. foramen ovale, 3. ductus arteriosus
52
It connects the pulmonary artery with the descending aorta.
Ductus arteriosus
53
It connects the umbilical vein to the inferior vena cava. This allows the majority of the highly oxygenated blood to enter the right atrium.
ductus venosus
54
It is an opening between the right and left atria. It may take up to 3 months for full closure.
foramen ovale
55
- Red blood cells are produced in the liver.
- Fusion of the palate is completed.
- External genitalia are developed to the point that sex of fetus can be noted with ultrasound.
- Eyelids are closed.
- Fetal heart tone can be heard by Doppler device.
Gestational Week 12
56
- Lanugo is present on head
- Meconium is form in the intestines
- teeth begin to form
- sucking motions are made with the mouth
- skin is transparent
Gestational Week 16
57
- Lanugo covers the entire body
- Venix caseosa covers the body
- Nails are formed
- Brown fats begin to develop
Gestational Week 20
58
- Eyes are developed.
- Alveoli form in the lungs and begin to produce surfactant.
- Footprints and fingerprints are forming.
- Respiratory movement can be detected.
Gestational Week 24
59
Eyelids are open. Adipose tissue develops rapidly. The respiratory system has developed to a point where gas exchange is possible, but lungs are not fully mature.
Gestational Week 28
60
Bones are fully developed. Lungs are maturing. Increased amounts of adipose tissue are present.
Gestational Week 32
61
Lanugo begins to disappear. Labia majora and minora are equally prominent. Testes are in upper portion of scrotum.
Gestational Week 36
62
Fetus is considered full term at 38 weeks. All organs/systems are fully developed.
Gestational Week 40
63
2 Functions of the placenta
1. Metabolic and gas exchange -In the placenta, fetal waste products and CO2 are transferred from the fetal blood into the maternal blood sinuses by diffusion. Nutrients such as glucose and amino acids and O2 are transferred from the maternal blood sinuses to the fetal blood through the mechanisms of diffuse and active transport.
64
2 Functions of the placenta
2. Hormone Production: The major hormones the placenta produces are progesterone; estrogen; human chorionic gonadotropin (hCG); and human placental lactogen (hPL), also known as human chorionic somatomammotropin.
65
4 hormones of the placenta:
Progesterone, Estrogen, hCg, hPL
66
Function of the progesterone in the placenta
Progesterone facilitates implantation and decreases uterine contractility.
67
Function of the estrogen in the placenta
Estrogen stimulates the enlargement of the breasts and uterus.
68
Function of the hCG in the placenta
hCG stimulates the corpus luteum so that it will continue to secrete estrogen and progesterone until the placenta is mature enough to do so. This is the hormone assessed in pregnancy tests. hCG rises rapidly during the first trimester and then rapidly declines.
69
Function of the hPL in the placenta
hPL promotes fetal growth by regulating available glucose and stimulates breast development in preparation for lactation.
70
What can cross the placenta?
- viruses such as rubella and cytomegaloviruses
| - drugs/avoid preg category C, D, or X.
71
Function of the Embryonic Membranes
The intact membranes help maintain a sterile environment by forming a barrier that prevents bacteria from entering the amniotic fluid through the vagina.
72
Contained within the amniotic sac. It is clear and is mainly composed of water. It also contains proteins, carbohydrates, lipids, electrolytes, fetal cells, lanugo, and vernix caseosa.
Amniotic fluid
73
4 Functions of Amniotic Fluid
● Cushions the fetus from sudden maternal movements.
● Prevents the developing human from adhering to the amniotic membranes.
● Allows freedom of fetal movement, which aids in symmetrical musculoskeletal development.
● Provides a consistent thermal environment.
74
2 types of amniotic fluid abnormalities
1. Polyhydramnios or hydramnios
| 2. Oligohydramnios
75
Refers to excess amount of amniotic fluid (1,500–2,000 mL). Newborns of mothers who experience polyhydramnios have an increased incidence of chromosomal disorders and gastrointestinal, cardiac, and neural tube disorders.
Polyhydramnios or hydramnios
76
Refers to a decreased amount of amniotic fluid (less than 500 mL at term or 50% reduction of normal amount). This is generally related to a decrease in placental function. Newborns of mothers who experienced oligohydramnios have an increased incidence of congenital renal problems.
Oligohydramnios
77
It connects the fetus to the placenta and consists of two umbilical arteries and one umbilical vein (AVA).
Umbilical Cord
78
It connects the fetus to the placenta and consists of two umbilical arteries and one umbilical vein. The arteries carry deoxygenated blood while the vein carries oxygenated blood
Umbilical Cord
79
A collagenous substance that protects the vessels from compression
Wharton’s Jelly
80
Newborns with only two vessels (one artery and one vein) have a 20% chance of having a cardiac or vascular defect.
Umbilical Vessels
81
Defined as the inability to conceive and maintain a pregnancy after 12 months (6 months for woman older than age 35 years) of unprotected sexual intercourse.
Infertility
82
Male causative factors in 5 categories
1. Endocrine
2. Spermatogenesis
3. Sperm antibodies
4. Sperm transport factor
5. Disorder of intercourse
83
Infertility causative factor: Endocrine
Endocrine causes include pituitary diseases, pituitary tumors, and hypothalamic diseases that may interfere with male fertility. Low levels of LH, FSH, or testosterone can also decrease sperm production.
84
Infertility causative factor: Spermatogenesis
Spermatogenesis is the process in which mature functional sperm are formed. Several factors can affect the development of mature sperm. These factors are referred to as gonadotoxins and include:
85
Examples of gonadotoxins
● Drugs (e.g., chemotherapeutics, calcium channel blockers, heroin, and alcohol)
● Infections/viruses (e.g., prostatitis, sexually transmitted infections [STIs], and contracting mumps after puberty)
● Systemic illness
● Prolonged heat exposure to the testicles (e.g., use of hot tubs, wearing tight underwear, and frequent bicycle riding)
● Pesticide exposure
● Radiation to the pelvic region
86
Infertility causative factor: Sperm antibodies
Sperm antibodies are an immunological reaction against the sperm that causes a decrease in sperm motility. This is seen mainly in men who have had either a vasectomy reversal or who experienced testicular trauma.
87
Infertility causative factor: Sperm transport factor
Sperm transport factor includes missing or blocked structures in the male reproductive anatomy that interfere with sperm transport (e.g., vasectomy, prostatectomy, inguinal hernia, and congenital absence of the vas deferens).
88
Infertility causative factor: Disorders of intercourse
Disorders of intercourse include erectile dysfunction (inability to achieve and/or maintain an erection), ejaculatory dysfunctions (retrograde ejaculation), anatomical abnormalities (hypospadias), and psychosocial factors that can interfere with fertility.
89
Female causative factors are classified into three major categories
1. Ovulatory dysfunction includes anovulation or inconsistent ovulation 2. Tubal and pelvic pathology factors 3. Cervical mucus factors
90
Female causative factors: Ovulatory dysfunction includes anovulation or inconsistent ovulation.
Ovulatory dysfunction includes anovulation or inconsistent ovulation. Causes of ovulatory dysfunction are hormonal imbalances, hyperthyroidism and hypothyroidism, high prolactin levels, premature ovarian failure (menopause prior to age 40), polycystic ovarian syndrome.
91
Female causative factors: Tubal and pelvic pathology factors
Tubal and pelvic pathology factors include damage to the fallopian tubes and uterine fibroids. Damage to the fallopian tubes is commonly related to previous pelvic inflammatory disease or endometriosis. Uterine fibroids, benign growths of the muscular wall of the uterus, can cause a narrowing of the uterine cavity and interfere with embryonic and fetal development, causing a spontaneous abortion.
92
Female causative factors: Cervical mucus factors
Cervical mucus factors – include infection and cervical surgeries such as cryotherapy, a medical intervention to treat cervical dysplasia. These factors may interfere with the ability of sperm to enter or survive in the uterus.
93
Risk Factors for Infertility in Women (9)
autoimmune disorders, diabetes, eating disorders or poor nutrition, excessive alcohol use, excessive exercising, history of cancer treated with gonadotoxic therapy or pelvic irradiation, obesity, older age, STI
94
Risk Factors for Infertility in Men (6)
- Environmental pollutants
- heavy use of alcohol, marijuana or cocaine,
- impotence
- older age
- STIs
- smoking
95
Common diagnostic tests to determine the underlying cause of infertility (7)
1. Screening for STI,
2. Laboratory test
3. Semen Analysis
4. Ovulatory dysfunction analysis
5. Endometrial biopsy
6. Hysterosalpingogram
7. Laparoscopy
96
What laboratory test to assess for hormonal levels in infertility?
Laboratory tests to assess hormonal levels (thyroid-stimulating hormone [TSH], FSH, LH, anti-Müllerian hormone [AMH], and testosterone)
97
4 types of ovulatory dysfunction analysis
1. Basal Body Temperature
2. Ovulatory prediction kits
3. Ovarian reserve testing
4. Detecting LH surge
98
What is semen analysis?
oThe man abstains for 2 to 3 days before providing a masturbated sample of his semen.
oSpecimens are either collected at the site of testing or brought to the site within an hour of collection.
oThe semen analysis includes volume, sperm concentration, motility, morphology, white blood cell count, immunobead, and mixed agglutination reaction test.
oSeveral semen analyses may be required since sperm production normally fluctuates.
99
Female takes temperature each morning before rising using a basal thermometer and records her daily temperature. Ovulation has occurred if there is a rise in the temperature by 0.4 F for 3 consecutive days.
Basal Body Temperature (BBT) charting
100
Used more often than BBT
Ovulatory prediction kits
101
It is used to determine size of the remaining egg reserve. On day 3 of the menstrual cycle, blood is drawn to evaluate the levels of FSH, estradiol and AMH. The same day, a transvaginal ultrasound is performed to assess ovarian volume and antral follicle amount.
Ovarian reserve testing
102
A rapid increase in LH 36 hours before ovulation can be testing with urine or serum. The urine test can be performed at home to assist in identifying the ideal time for intercourse when pregnancy is desired.
Detecting LH surge
103
Assess the response of the uterus to hormonal signals that occur during the cycle. The biopsy is performed at the end of the menstrual cycle in the clinical or medical office.
Endometrial biopsy
104
Radiological examination that provides information about the endocervical canal, uterine cavity, and fallopian tubes. Under fluoroscopic observation, dye is slowly injected through the cervical canal into the uterus. This examination can detect tubal problems such as adhesions or occlusions and uterine abnormalities such as fibroids, bicornate uterus and uterine fistulas.
Hysterosalpingogram
105
It uses an instrument called laparoscope to visualize and inspect the ovaries, fallopian tubes, and uterus for abnormalities such as endometriosis and scarring.
Laparoscopy
106
Male infertility patient’s treatment (6)
1. Hormonal therapy for endocrine factors
2. Lifestyle changes to correct abnormal sperm count: stress reduction, improved nutrition, smoking cessation and elimination of drugs
3. Corticosteroids to decrease the production of the sperm antibodies
4. Antibiotics to clear infections of the genitourinary tract
5. Repair of varicocele or inguinal hernia to facilitate sperm transport
6. Transurethral resection of ejaculatory ducts to treat disorders related to intercourse.
107
Female infertility treatment (4)
1. Treatment for anovulation: lifestyle changes (stress reduction, improved nutrition, smoking cessation, and elimination of drugs that have an adverse effect on fertility) and drug therapy to stimulate ovulation: clomiphene citrate, letrozole; injectable gonadotropins; the gonadotropin-releasing hormone [GnRH] pump; and bromocriptine.
2. Surgery to open the fallopian tubes if tubal abnormalities are present.
3. Removal of uterine fibroids through a surgical procedure called myomectomy
4. Antibiotics to treat cervical infection.
108
Clomiphene Citrate (Clomid) Indication
```
Clomiphene Citrate (Clomid)
● Indication: Anovulatory infertility
```
109
Clomiphene Citrate (Clomid) Action and Common Side Effects (8)
● Action: Stimulates release of FSH and LH, which stimulates ovulation
● Common side effects: Hot flashes, breast discomfort, headaches, insomnia, bloating, blurry vision, nausea, vaginal dryness
110
Clomiphene Citrate (Clomid) Route and Dose; Nursing Actions
● Route and dose: PO; 50–200 mg/day from cycle day 3–7.
● Nursing actions:
● Provide information on use of medication and its side effects.
Instruct woman not to drive if she is experiencing blurry vision.
111
Common Assisted Fertility Technologies (6)
1. AI
2. Testicular sperm aspiration
3. In vitro fertilization (IVF)
4. Zygote intrafallopian transfer (ZIFT)
5. Gamete intrafallopian transfer (GIFT)
6. Embryo transfer (ET)
112
Procedure: sperm that has been removed from semen is deposited directly into the cervix or uterus using a plastic catheter. The sample is collected by masturbation, and the sperm are separated from the semen and prepared
Artificial insemination (AI):
113
Examples of fertility conditions where artificial insemination is used (4)
(1) poor cervical mucus production as a result of previous surgery of the cervix, (2) anti-sperm antibodies, (3) diminished amount of sperm, and (4) diminished sperm motility.
114
Sperm are aspirated or extracted directly from the testicles. Sperm are then microinjected into the harvested eggs of the female partner. This is also referred to as intra-cytoplasmic injection.
Testicular sperm aspiration
115
Examples of fertility conditions where Testicular sperm aspiration is used (3)
(1) had an unsuccessful vasectomy reversal, (2) have an absence of vas deferens, or (3) have an extremely low sperm count or no sperm in their ejaculated semen.
116
A procedure in which oocytes are harvested and fertilization occurs outside the female body in a laboratory.
In vitro fertilization (IVF)
117
Zygote is placed into the fallopian tube via laparoscopy 1 day after the oocyte is retrieved from the woman and IVF is used.
Zygote intrafallopian transfer (ZIFT)
118
Sperm and oocytes are mixed outside the woman’s body and then placed into the fallopian tube via laparoscopy. Fertilization takes place inside the fallopian tube.
Gamete intrafallopian transfer (GIFT)
119
When is GIFT procedure used?
This procedure is used when there has been (1) a history of failed infertility treatment for anovulation, (2) unexplained infertility, and (3) low sperm count.
120
An embryo is placed in the uterine cavity via a catheter. Example of fertility condition in which this procedure is used is when the fallopian tubes are blocked.
Embryo transfer (ET)
121
Breast Changes: due to stretching of skin to accommodate enlarging breast tissue
Striae
122
Softening of the cervix
Goodell’s sign
123
Softening of the lower uterine segment
Hegar’s sign
124
bluish coloration of cervix, vaginal mucosa, and vulva
Chadwick’s sign
125
Cardiovascular changes during pregnancy
- Decrease in peripheral vascular resistance = decrease BP
- Increase blood volume 40-45%= hypovolemia
- Increase in cardiac output = increase HR
- increase WBC = up to 16, 000 mmm in the absence of infection
126
What is Supine hypotensive syndrome?
In supine position the enlarged uterus compresses the inferior vena cava, causing reduced blood flow back to the right atrium and a drop in cardiac output and blood pressure.
127
Physiological Changes in GI system during pregnancy
Increased levels of hCG and altered carbohydrate metabolism
128
Altered Gait
Waddle Gait
129
Abdominal muscles stretch due to enlarging uterus
Diastasis recti
130
Integumentary System Physiological Changes in pregnancy
- Linea nigra
- Melasma (chloasma)
- Increased pigmentation of nipples, areola, vulva, scars, and moles
131
3 parts of the uterus
- Fundus or upper portion
- isthmus or lower segment
- cervix - lower narrow part
- the cervical ox - opening of the cervix that dilates during labor to allow passage of the fetus
132
Intermittent, painless, and physiological uterine contractions,
Braxton-Hicks contractions
133
It begin in the second trimester, but some women do not feel them until the third trimester. These contractions are irregular with no particular pattern. As the uterus enlarges, they are more noticeable
Braxton-Hicks contractions
134
It is a hypotensive condition result from a woman lying on her back in mid to late pregnancy. In a supine position, the enlarge uterus compresses the inferior vena cava, leading to a significant drop in cardiac output and blood pressure that results in the woman feeling dizzy and faint.
Supine Hypotensive Syndrome
135
Body Mass Index Categories
- Underweight: Less than 18.5
- Normal weight: 18.5–24.9
- Overweight: 25–29.9
- Obesity class I: 30–34.9
- Obesity class II: 35–39.9
- Obesity class III: 40 or greater
136
Decrease risk of neural tube defects
Folic acid supplementation
137
All subjective signs of pregnancy (i.e., physiological changes perceived by the woman
Presumptive signs of pregnancy
138
Amenorrhea: absence of menstruation
Presumptive signs
139
A woman’s first awareness of fetal movement; occurs around 18 to 20 weeks’ gestation in primigravidas (between 14 and 16 weeks in multigravidas)
Quickening
140
Quickening: A woman’s first awareness of fetal movement; occurs around 18 to 20 weeks’ gestation in primigravidas (between 14 and 16 weeks in multigravidas)
Presumptive signs
141
Objective signs of pregnancy and include all physiological and anatomical changes that can be perceived by the health care provider
Probable signs of pregnancy
142
Chadwick’s sign: Bluish-purple coloration of the vaginal mucosa, cervix, and vulva seen at 6 to 8 weeks
Probable signs of pregnancy
143
Goodell’s sign: Softening of the cervix and vagina with increased leukorrheal discharge; palpated at 8 weeks
Probable signs of pregnancy
144
Hegar’s sign: Softening of the lower uterine segment; palpated at 6 weeks
Probable signs of pregnancy
145
Also referred to as the mask of pregnancy: brownish pigmentation over the forehead, temples, cheek, and/or upper lip
Melasma (chloasma) / Probable signs of pregnancy
146
Dark line that runs from the umbilicus to the pubis
Linea nigra / Probable signs of pregnancy
147
Become darker; more evident in primigravidas and dark-haired women
Nipples and areola / Probable signs of pregnancy
148
A light tap of the examining finger on the cervix causes fetus to rise in the amniotic fluid and then rebound to its original position; occurs at 16 to 18 weeks
Ballottement / Probable signs of pregnancy
149
Positive pregnancy test results
Probable signs of pregnancy
150
Objective signs of pregnancy (noted by the examiner) that can only be attributed to the fetus
Positive signs of pregnancy
151
Give 3 positive signs of pregnancy
● Auscultation of the fetal heart, by 10 to 12 weeks’ gestation with a Doppler
● Observation and palpation of fetal movement by the examiner after about 20 weeks’ gestation
● Sonographic visualization of the fetus: Cardiac movement noted at 4 to 8 weeks
152
First day of LMP through 14 completed weeks
First trimester
153
15 weeks through 28 completed weeks
Second trimester
154
29 weeks through 40 completed weeks
Third trimester
155
Begins with the first day of last menstrual period (LMP) and ends with the onset of labor
Antepartum (antepartal) period aka prenatal period
| known as intrapartal period
156
EDD meaning
Estimated due date
157
Naegele’s Rule
Naegele’s rule is the standard formula for determining an EDD based on the LMP: First day of LMP – 3 months + 7 days.
158
Classification of Deliveries From 37 Weeks of Gestation
Early term: 37 0/7 weeks through 38 6/7 weeks
Full term: 39 0/7 weeks through 40 6/7 weeks
Late term: 41 0/7 weeks through 41 6/7 weeks
Post term: 42 0/7 weeks and beyond
159
refers to the number of completed weeks of fetal development, calculated from the first day of the last normal menstrual period
Gestational age
160
It refers to the total number of times a woman has been pregnant, without reference to how many fetuses there were with each pregnancy or when the pregnancy ended. Twins counted as 1 and it includes current pregnancy
Gravida
161
Refers to the number of births after 20 weeks’ gestation were live birth or stillbirths.
Para
162
GTPAL
(gravida, term, para, abortion, living)
163
GTPAL
● G = total number of times pregnant (same as G/P system)
● T = number of term infants born (between 38- and 42-weeks’ gestation)
● P = number of preterm infants born (between 20 and 37 6/7 weeks)
● A = number of abortions (either spontaneous or induced) before 20 weeks’ gestation (or less than 500 grams at birth)
● L = the number of children currently living
164
It is the entire period a woman is pregnant, through the birth of the baby.
Prenatal period
165
A woman who has never been pregnant or given birth.
Nulligravida
166
A woman who is pregnant for the first time
Primigravida
167
A woman who is pregnant for at least the second time.
Multigravida
168
An entire period a woman is pregnant, through the birth of the baby.
Prenatal period
169
First Trimester Lab/Diagnostic studies - Initial Visit
- Blood type and Rh Factor
- Antibody screen
- CBC (Hemoglobin, Hematocrit, RBC count, WBC count, Platelet count)
- RPR, VDRL (syphilis serology)
- HIV screen
- Hepatitis B screen (surface antigen)
- Genetic screening may be done between 10 0/7 weeks and 13 6/7 weeks
- Rubella titer
- PPD (tuberculosis screen)
- Urinalysis
- Urine culture and sensitivity
- Pap smear
- Gonorrhea and chlamydia cultures
- Ultrasound
170
First Trimester Lab/Diagnostic studies - Return visits (every 4 weeks)
* Triple screen, quad screen, or penta screen
* Ultrasound
* Screening for gestational diabetes at 24–28 weeks
* Hemoglobin and hematocrit
* Antibody screen if Rh negative
* Administration of RhoGAM if Rh negative and antibody screen negative
171
Third Trimester Lab/Diagnostic studies
Group B streptococcus screening: Vaginal and rectal swab cultures done at 35–37 weeks’ gestation to determine presence of GBS bacterial colonization before the onset of labor in order to anticipate intrapartum antibiotic treatment needs
Additional screening testing:
• H&H if not done in second trimester
• Repeat GC, chlamydia, RPR, HIV, HBsAg (if indicated and not done in late second trimester)
• 1-hour glucose challenge test at 24–28 weeks
172
AWHONN advocates for universal screening for all pregnant women and recommends the _ _ _s of patient care to guide nurses caring for victims of abuse
```
A- Alone
B- Beliefs
C- Confidentiality
D- Documentation
E- Education
S- Safety
```
173
Warning/Danger Signs of the First Trimester (6)
* Abdominal cramping or pain indicates possible threatened abortion, UTI, or appendicitis.
* Vaginal spotting or bleeding indicates possible threatened abortion.
* Absence of fetal heart tone indicates possible missed abortion.
* Dysuria, frequency, and urgency indicate possible UTI.
* Fever or chills indicate possible infection.
* Prolonged nausea and vomiting indicate possible hyperemesis gravidarum, increased risk of dehydration.
174
Warning/Danger Signs of the Second Trimester (6)
* Abdominal or pelvic pain indicates possible preterm labor (PTL), UTI, pyelonephritis, or appendicitis.
* Absence of fetal movement once the woman has been feeling daily movement indicates possible fetal distress or death.
* Prolonged nausea and vomiting indicate possible hyperemesis gravidarum, at risk for dehydration.
* Fever and chills indicate possible infection.
* Dysuria, frequency, and urgency indicate possible UTI.
* Vaginal bleeding indicates possible infection, friable cervix due to pregnancy changes, placenta previa, abruptio placenta, or PTL.
175
Signs and symptoms of PTL (6)
```
● Rhythmic lower abdominal cramping or pain
● Low backache
● Pelvic pressure
● Leaking of amniotic fluid
● Increased vaginal discharge
● Vaginal spotting or bleeding
```
176
Signs and symptoms of hypertensive disorders (3)
● Severe headache that does not respond to usual relief measures
● Visual changes
● Facial or generalized edema
177
Warning/Danger Signs of the Third Trimester
* Abdominal or pelvic pain (PTL, UTI, pyelonephritis, appendicitis)
* Decreased or absent fetal movement (fetal hypoxia or death)
* Prolonged nausea and vomiting (dehydration, hyperemesis gravidarum)
* Fever, chills (infection)
* Dysuria, frequency, urgency (UTI)
* Vaginal bleeding (infection, friable cervix due to pregnancy changes or pathology, placenta previa, placenta abruptio, PTL)
* Signs/symptoms of PTL: Rhythmic lower abdominal cramping or pain, low backache, pelvic pressure, leaking of amniotic fluid, increased vaginal discharge
* Signs/symptoms of hypertensive disorders: Severe headache that does not respond to usual relief measures, visual changes, facial or generalized edema.
178
Nursing Action: Emotional lability (throughout pregnancy)
Reassure the woman of the normalcy of response.
Encourage adequate rest and optimal nutrition.
Encourage communication with partner/significant support people.
Refer to pregnancy support group.
179
Nursing Action: Tenderness, enlargement, upper back pain (throughout pregnancy; tenderness mostly in the first trimester)
Encourage the woman to wear a well-fitting, supportive bra.
| Instruct woman in correct use of good body mechanics.
180
Nursing Action: Braxton-Hicks contractions (mid-pregnancy onward)
Reassure the woman those occasional contractions are normal.
Instruct the woman to call her provider if contractions become regular and persist before 37 weeks.
Ensure adequate fluid intake.
Recommend a maternity girdle for uterus support.
181
Nursing Action: Supine hypotension (mid-pregnancy onward)
Instruct the woman to avoid supine position from mid-pregnancy onward.
Advise her to lie on her side and rise slowly to decrease the risk of a hypotensive event.
182
Nursing Action: Orthostatic hypotension
| Anemia (throughout pregnancy; more common in late second trimester)
Advise woman to keep feet moving when standing and avoid standing for prolonged periods.
Instruct to rise slowly from a lying position to sitting or standing to decrease the risk of a hypotensive event.
Encourage the woman to include iron-rich foods in daily dietary intake and take iron supplementation.
183
Nursing Action: Diastasis recti (later pregnancy)
```
Diastasis recti (later pregnancy) Instruct the woman to do gentle abdominal strengthening exercises (e.g., tiny abdominal crunches, may cross arms over abdomen to opposite sides for splinting, no sit-ups).
Teach proper technique for sitting up from lying down (i.e., roll to side, lift torso up using arms until in sitting position).
```
184
Ambivalent Feelings Toward Pregnancy
It is common for women to experience ambivalent feelings toward pregnancy during the first trimester. These feelings decrease as pregnancy progresses.
185
Paternal Developmental Taks (3)
1. Announcement Phase
2. Moratorium Phase
3. Focusing Phase
186
Announcement phase
- Occurs when pregnancy is revealed
- Common if men to feel ambivalence
- accept the biological fact of pregnancy
- Men will begin to take the expectant father role
187
Moratorium Phase
Men’s main developmental task during this phase is to accept the pregnancy. This includes accepting the changing body and emotional state of his partner, as well as accepting the reality of the fetus, especially when fetal movement is felt.
188
Focusing Phase
- Men will be actively involved in the pregnancy and their relationship with the child.
- think of themselves as father
- men participate in L & D and newborn
