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303 Cards in this Set
- Front
- Back
Chadwick's sign -- is it a presumptive, probable, or positive sign of pregnancy?
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probable
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Hegar's sign -- is it a presumptive, probable, or positive sign of pregnancy?
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probable
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Goodwell's sign -- is it a presumptive, probable, or positive sign of pregnancy?
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probable
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fetal heart tones -- is it a presumptive, probable, or positive sign of pregnancy?
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positive
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positive pregnancy test (peeing on the stick) -- is it a presumptive, probable, or positive sign of pregnancy?
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probable
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braxton-hicks contractions -- is it a presumptive, probable, or positive sign of pregnancy?
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probable
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fetal outline felt by examiner -- is it a presumptive, probable, or positive sign of pregnancy?
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positive
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quickening -- is it a presumptive, probable, or positive sign of pregnancy?
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presumptive
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linea nigra -- is it a presumptive, probable, or positive sign of pregnancy?
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presumptive
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darkened areola -- is it a presumptive, probable, or positive sign of pregnancy?
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presumptive
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striae gravidarum -- is it a presumptive, probable, or positive sign of pregnancy?
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presumptive
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chloasma -- is it a presumptive, probable, or positive sign of pregnancy?
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presumptive
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amenorrhea -- is it a presumptive, probable, or positive sign of pregnancy?
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presumptive
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What's the McDonald method of calculating gestational age?
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gestational age is approx. equal to the fundal height measured from the symphysis pubis
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what is gravida?
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# of pregnancies
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What's para?
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# of pregnancies in which the fetus/fetuses reach viability (at least 20 weeks or 500g) regardless of whether the fetus is born alive or not.
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What's GTPALM?
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G = gravidity
T = term births (38 wks or more) P = preterm births (20wks) A = abortions/miscarriages (before 20 wks) L = living kids M = Multiple gestation |
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blood volume increases by how much during pregnancy?
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35-50%
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T/F. WBC count decreases during pregnancy.
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False.
WBC count increases by 10,000/mm^3 |
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does maternal pulse rate increase or decrease during pregnancy?
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increase
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oxytocin given for induction of labor is always given by which route?
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IV Piggyback
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the most noninvasive way to attempt to induce labor is:
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nipple stimulation -- to trigger the release of endogenous oxytocin
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what does high levels of Alpha-fetoprotein (AFP) in the amniotic fluid indicate?
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neural tube defects
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what does low levels of Alpha-fetoprotein (AFP) in the amniotic fluid indicate?
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Down syndrome
or gestational trophoblastic disease (hydatidiform mole) |
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what is the normal fetal HR range?
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110-160 bpm
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T/F. Variability of fetal HR is normal.
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True.
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What is hyperemesis gravidarum?
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excessive nausea and vomiting r/t high hCG lvls that is prolonged past 12 weeks of gestation and results in 5% weight loss from pre-pregnancy weight, dehydration, F&E imbalance, etc.
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What do you look for in the urinalysis of a pt suffering from hyperemesis gravidarum?
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- ketones and acetones
- increased specific gravity |
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Main difference between placenta abruptio and placenta previa:
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placenta previa = painless bleeding
placenta abruptio = painful |
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things to monitor for when on mag sulfate:
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- BP
- UO - reflexes - respirations |
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what positions can you place your pt who has a cord prolapse?
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- trendelenburg
- knee-chest - side-lying with hips elevated |
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Pt's having preterm labor.
Place in order of priority: - apply fetal monitor - infuse prescribed IV tocolytic - administer betamethisone - pt teaching regarding bed rest |
1. infuse IV tocolytic (hydration and medication stops preterm labor)
2. administer betamethisone (to develop fetal lungs in case of early delivery) 3. apply fetal monitor (to monitor contractions and fetal HR) 4. bedrest teaching |
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what's acrocyanosis?
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pink body with blue extremities
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what pH is amniotic fluid? and what color would the nitrazine paper turn into?
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pH 6.5-7.5
bluish-greenish, dark blue |
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when can the sex of the fetus be determined?
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at 12 weeks (3 months)
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At which gestational age are all body organs formed?
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8 weeks (2 months)
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When does the fetal heart begin the beat? when can you hear it using a Doppler? when can you hear it with a fetoscope?
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- begins to beat at 4 weeks (1 mo.)
- hear it w/ a Doppler at 8-12 weeks (2-3 mo.) - hear it w/ a fetoscope at 20 weeks (5 mo.) |
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brown fat present at what gestational age?
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28 weeks (7 months)
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Fetus gains ability to hear at what gestational age?
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24 weeks (6 months)
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what's the ductus arteriosus?
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duct that connects the pulmonary artery with the aorta allowing blood to bypass the lungs
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What's the ductus venosus?
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shunts blood from the umbilical vein to the inferior vena cava allowing most of the blood to bypass the liver
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what serves as the respiratory organ for the developing fetus?
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the placenta
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T/F. the umbilical vein carries oxygenated blood.
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True.
It carries oxygenated blood and nutrients from the placenta (maternal supply) to the fetus |
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T/F. Have the pt void before performing an ultrasound.
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False.
Pts should drink lots of fluids and fill the bladder to stabilize the uterus for an US. |
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T/F. Always have the pt sign a consent form before performing an ultrasound or any other procedure.
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False.
Pts do not need to sign a consent prior to an US. |
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Define fetal lie:
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relationship of the mom's spine to the fetal spine.
(transverse or parallel/longitudinal) |
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Define: fetal attitude:
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relationship of fetal body parts to one another.
(flexion or extension) |
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define fetal presentation:
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the part of the fetus that enters the pelvic inlet first.
(occiput, mentum, scapula, or sacrum) |
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T/F. Iron needs for lactating women are about the same as non-lactating women.
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True.
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a positive contraction stress test indicates a need for what other test?
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biophysical profile
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what is done to relieve hydramnios?
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amniocentesis
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can oxytocin cause decreased or increased blood pressure in postpartum pts?
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increased blood pressure
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T/F. amniocentesis can determine the sex of the fetus.
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True.
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can amniocentesis be used to determine fetal lung maturity?
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yes but only during the last trimester
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T/F. Amniocentesis is used to diagnose polyhydramnios.
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False.
ultrasounds are used to diagnose polyhydramnios, but an amniocentesis can be used to relieve it. |
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what are the 3 cardinal signs of an ectopic pregnancy?
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- abdominal pain
- vaginal bleeding - a positive pregnancy test |
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T/F. hyperemesis gravidarum is a neurologic disorder.
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False.
The cause of hyperemesis gravidarum isn't known |
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approximately where is the fundal height at 20 week gestation?
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at the umbilicus.
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the uterus deviates to which side in early pregnancy?
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right side.
(so many women experience RLQ pain/pulling) |
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Adverse reactions to Oxytocin in the mother such as hypertension and fluid overload are due to what effects of drug?
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due to its antidiuretic effects
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what are the 5 components of a biophysical profile?
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- nonstress test
- fetal tone - fetal breathing - fetal motion - quantity of amniotic fluid |
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Conception- definition
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defines beginning of pregnancy, results from the union of single egg and sperm
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Sequential process of conception…
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1. Gamete formation 2. Ovulation 3. Fertilization (in fallopian tube) 4. Implantation (in the uterus)
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Implantation occurs when…
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6-10 days after conception
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Function of chorionic villi
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develop out of trophoblast and extend into the endometrium. Obtain oxygen and nutrients, dispose of carbon dixide and waste products
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Edometrium becomes what after implantation
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It becomes the decida after implantation. The three decida layers become the fetal membranes
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Pre-embryonic (ovum)
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conception until day 14. Primary germ layers
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Embryo
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day 15 until 8 weeks after conception (or until the crown-rump length 3cm). Stage when cell division is most vulnerable to malformation caused by teratogens. By 8 weeks all organ systems and external structures are present.
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Fetus
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stage 9 weeks until pregnancy.
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Viability
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capability of the fetus to survive outside the uterus. Previously 28 weeks post conception, now may be 20 weeks. Limitations based upon CNS function and oxygenation capacity of lungs.
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Fetal membranes
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Chorion, amnion, amniotic fluid, yolk sac, umbilical cord, placenta
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Chorion
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develops from the trophoblast and contains the ______ villi on the surface, becomes the fetal side of the placenta, contains the major umbilical blood vessels, the villi atrophy and degenerate, leaving a smooth ______ membrane
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Amnion
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develops from the interior of the blastocyst. Forms on the side of the amniotic cavity opposite the blastocyst. Embryo draws the amnion around itself, forming a fluid-filled sac
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Amniotic fluid
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Maintains constant body temp, source of oral fluid, repository for waste, cushioning, freedom of movement (prevents entanglement with membranes) chemical and genetic studies of the fluid provide health information
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Oligohydramnios
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too little amniotic fluid. May indicate fetal renal abnormalities (baby not producing urine which
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Polyhydramnios
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too much amniotic fluid. May indicate GI or other fetal malformations (baby has a hard time swallowing)
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Yolk Sac
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transfers nutrients and oxygen, forms primative blood cells. (Seen with the embryo functions until the placenta can take over)
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Wharton's jelly
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connective tissue that prevents compression of the cord
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Nuchal cord
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when cord wraps around the fetal neck
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Battledore placenta
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when the umbilical cord is located peripherally on the placenta, instead of the usual central insertion. (More risk for compression of the umbilical cord)
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Placenta
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begins to form at implantation, divided into 15-20 separate sections (cotyledons), which function as independent units, the whole of which is the ______. Maternal-embryonic circulation is separated by the placenta (the two circulation systems do not mix!) Means of metabolic exchange, produces hormones: 1. Human chorionic ganadotropin (hCG) 2. Human placental lactogen (hPL) 3. Progestrone 4. Estriol
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Human chrionic gonadotropin (hCG)
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Its role is to prevent the disintegration of the corpus luteum of the ovary and thereby maintain progesterone production that is critical for a pregnancy in humans.
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Human placental lactogen (hPL)
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Produced by the placenta. It modifies the metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus. HPL has anti-insulin properties, which is why some women get gestational diabetes
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Progesterone
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"Produced by the placenta. Supports gestation, During implantation and gestation, ___appears to decrease the maternal immune response to allow for the acceptance of the pregnancy, decreases contractility of the uterine smooth muscle (why GI also slows), inhibits lactation during pregnancy. The fall___ levels following delivery is one of the triggers for milk production, a drop in ____levels is possibly one step that facilitates the onset of labor.
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Estriol
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Produced by the placenta. Helps maintain placental function
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Fetal circulation
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Placenta - ductous venosus - Inferior vena cava (bypassing the liver) - Right atrium - passes through the foramen ovale - left atrium - left ventricle - aorta -
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Gravidity
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pregnancy
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Multigravida
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woman with two or more pregnancies
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primigravida
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women pregnant for the first time
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nulligravida
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woman who has never been pregnant
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Placenta
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begins to form at implantation, divided into 15-20 separate sections (cotyledons), which function as independent units, the whole of which is the ______. Maternal-embryonic circulation is separated by the placenta (the two circulation systems do not mix!) Means of metabolic exchange, produces hormones: 1. Human chorionic ganadotropin (hCG) 2. Human placental lactogen (hPL) 3. Progestrone 4. Estriol
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Human chrionic gonadotropin (hCG)
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produced by the fetus and later the placenta. Levels can first be detected by a blood test about 11 days after conception and about 12 - 14 days after conception by a urine test (?) Its role is to prevent the disintegration of the corpus luteum of the ovary and thereby maintain progesterone production that is critical for a pregnancy in humans.
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Human placental lactogen (hPL)
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Produced by the placenta. It modifies the metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus. HPL has anti-insulin properties, which is why some women get gestational diabetes
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Progesterone
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"Produced by the placenta. Supports gestation, During implantation and gestation, ___appears to decrease the maternal immune response to allow for the acceptance of the pregnancy, decreases contractility of the uterine smooth muscle (why GI also slows), inhibits lactation during pregnancy. The fall___ levels following delivery is one of the triggers for milk production, a drop in ____levels is possibly one step that facilitates the onset of labor.
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Estriol
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Produced by the placenta. Helps maintain placental function
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Fetal circulation
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Placenta - ductous venosus - Inferior vena cava (bypassing the liver) - Right atrium - passes through the foramen ovale - left atrium - left ventricle - aorta -
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Gravidity
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pregnancy
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Multigravida
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woman with two or more pregnancies
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primigravida
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women pregnant for the first time
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nulligravida
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woman who has never been pregnant
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parity
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number of pregnancies where fetus reached viability (not affected by being born alive or stillborn)
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nullipara
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woman who has not completed a pregnancy where the fetus reached viability (nullip)
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primipara
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woman pregnant for the first time (primip)
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Multipara
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woman who has completed two or more pregnancies to viability (multiple)
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Term
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a pregnancy from week 38 -42 of gestation
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Preterm
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pregnancy between 20 -37 weeks gestation
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Postdate or post-term
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pregnancy that goes beyond 42 weeks gestation
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S Ab
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Spontaneous abortion
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T Ab
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Therapeutic abortion
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E Ab
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Elective abortion
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Pregnancy tests
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Early detection of hCG, based on beta subunit, urine tests sensitive to 25 mIU/ml. Can pick up about 10-17 days after conception (about the time of the first missed menses) Serum tests may pick up several days earlier
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Presumptive signs of pregnancy (felt by the woman)
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Amenorrhea, nausea/vomiting, fatigue, breast changes
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Probable signs of pregnancy (observed by the examiner)
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Hegar sign, Ballottement, Pregnancy test
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Positive signs of pregnancy
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Hearing fetal heart tones, visualizing fetus (ultrasound), palpating fetal movements
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Hegar sign
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softening of lower uterine segment- about 6 weeks of gestation)
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Ballottement sign
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passive movement of the floating fetus (about 16-18 weeks)
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Changes to uterus in pregnancy
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Fundal height palpable about the symphysis pubis between 12-14 weeks. Level of umbilicus at 20-22 weeks. Reach xiphoid process at term. Begins to drop between 38-40 weeks ("lightening"). Braxton-Hicks sign
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Braxton- Hicks sign
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false labor or practice contractions
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Changes to Cervix in pregnancy
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Goodell sign- softening of cervical tip (6 weeks)
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Goodell sign
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softening of cervical tip (6 weeks)
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Changes to vagina/ulva in pregnancy
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Chadwick sign, leukorrhea, mucous plug
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Chadwick sign
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deepened color, violet-bluish, as early as 6 weeks.
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Leukorrhea
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white or gray vaginal mucous discharge
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Mucous plug
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gelatinous mucus in the cervical canal
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Changes in breasts in pregnancy
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Increased sensitivity (tingling to sharp pain), nipples and areolae darken, Montgomery's turbercles (hypertrophy of sebaceous glands), visible blood vessels
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Changes in cardiac in pregnancy
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more audible S1 and S2, shift in PMI, BP-1st trimester= same as pre-pregnancy, 2nd trimester= decrease in systolic and diastolic by 5-10 mmHg then after 20 weeks slowly increases back to first trimester at term. Blood volume increases by 1500 ml (40-50% above non-preg levels). CO increases 30-50%, WBC count increases in 2nd and 3rd trimesters. Anemia develops because of hemodilution (plasma increases more than RBC production)
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Hemodilution
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plasma increases more than RBC production)
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Changes in respirations in pregnancy
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progesterone and estrogen increase sensitivity to carbon dioxide, leading to perception of SOB
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Changes in renal system in pregnancy
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Dilation of renal pelvis and ureters in response to increase urine volume, secondary to increased blood volume. More susceptibility to UTI.
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Skin changes in pregnancy
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Chloasma, linea nigra, striae gravidarum, palmar erythema, gingival hypertrophy.
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Chloasma
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mask of pregnancy, tan or dark discoloration
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Linea Nigra
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from pubis to the top of the fundus in the midline
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Striae Gravidarum
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Stretch marks, caused by collagen separation in the skin- color depends on women's skin color
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Palmar erythema
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reddening of the palms at the thenar and hypothenar eminences
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Changes in musculoskeletal system in pregnancy
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pelvis tilts forward, increasing lordosis, waddling gait, relaxation and increased mobility of pelvic joints, ligaments, separation of the rectus abdominis layers in 3rd trimester.
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Changes in neurologic system in pregnancy
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Carpal tunnel syndrome, pain from lordosis, tension headaches, faintness, occasional syncope, postural hypotension, hypoglycemia
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Changes in GI in pregnancy
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Pica, ptyalism, heartburn, constipation, hemorrhoids
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Pica
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crave non foods
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Lordosis
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inward curvature of back
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ptyalism
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excessive saliva
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Changes in endocrine system in pregnancy
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Thyroid enlargement due to increased gland activity, pancreas= maternal glucose levels decrease because of fetal demand so insulin production decreases with it, as pregnancy hormones make it more difficult to use insulin and can lead to gestational diabetes.
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Issues in the response to pregnancy
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Financial, realities of labor and birth, family dynamics
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Mother's reactions
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Intendedness, Ambivalence, Acceptance, Introversion, Mood swings, Changes in body image
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Couvade
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traditionally referred to the rituals and taboos by the male to signify transition to father hood. Now term describes the unintended development of the physical symptoms. Tend to have a higher degree of paternal role participation.
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positive pregnancy Test
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measures the beta subunit of human chorionic gonadotropin (hCG) hormone in urine or serum.
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hCG
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hormone secreted by the trophoblast to encourage progestrone and estrogen production by the luteum to maintain the pregnancy until the placentas fully develops and takes over production
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elevated hCG commonly causes
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causes n&v, changes carbohydrate metabolism, triggered by hPL (human placental lactogen)
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Nausea and vomiting of pregnancy (NVP)
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known as “morning sickness”, but can occur at any time of day. (most common on empty stomach)
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“morning sickness”,
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Related to the high levels of hCG and hPL, but we are still researching other causes and contributing factors. Stress and anxiety seem to exacerbate NPV in some women, and may have a contributing factor.
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NVP happens when.
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Usually appears around gestational week 6 and is gone around week 12.
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Fatigue in pregnancy happens when..
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Common through the first trimester, and related to the high levels of progesterone secreted by the corpus luteum and then by the placenta.
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fatigue improves when
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Generally improves around gestational week 14
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Breast tenderness
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Caused by hormonally induced growth of the secretory ductal system.
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Breast tenderness is common when
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Common in first trimester, but may persist.
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2 methods of ultrasound
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"Transvaginal -used in 1st trimester because it is still small Transabdominal
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Appropriate uses of ultrasound
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detect gestational sac at 5 to 6 wks after LMP, detect fetal HR at 6 to7 wks, detect fetal breathing movement 10 to 11 wks of preg.
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assessment in 1st trimester with ultrasound
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Nothing can be seen before 4 weeks (before g.sac) Confirm pregnancy and viability. Determine gestational age (by crown-rump length of embryo before 12 wks) Rule out ectopic pregnancy, Detect multiple gestation, Detect maternal abnormalities
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Second trimester use of ultrasound
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"Confirm dates, Confirm viability (fetal heart sounds), Detect poly, Detect congential anomalies, Detect IUGR, Confirm placenta placement, Can detect the gender at this time too
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Daily Fetal Movement Count
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"""kick counts"" Begin in late second trimester Notify provider if no movement in 12 hours Fewer than 3 movements in one hour warrants further evaluation by non-stress testing or biophysical profile
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Third trimester use of ultrasound
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Confirm viability, Detect macrosomia (large birth weight), Detect congenital anomalies- that may not have shown up earlier), Detect IUGR, Determine fetal position, Detect placenta previa or abruption , Biophysical profile (BPP)= Amniotic fluid volume assessment (AFI) , Doppler flow studies, Detect placental maturity Determine gestational age (by crown-rump lentgh of embryo before 12 weeks.
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high AFP level
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may indicate fetal neural tube defect, multiple gestation, or preg that is further along than believed.
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low AFP level
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risk of Down syndrome, or trisomy 18
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alpha-fetoprotien (AFP
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fetal protein that is excreted from the fetal yolk sac during the first 6 wks of pregnancy then production os taken over by the fetal liver.
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high levels of hCG and inhibin-A and low UE
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risk of down syndrome
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AFI index
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Measure depth of fluid volume in all four quadrants around mother’s umbilicus, and add the measurements together
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Amniocentesis
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used for genetic dx, done btwn 15 and 20 wks for NTD, AFP levels, blood type, DNA. Later done btwn 30 to 35 wks dor lung maturity tests
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Oligohydramnios
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If less than 5 cm AFI
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Polyhydramnios
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If greater than 20 cm AFI
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Electronic Fetal Monitoring used when..
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Used to assess women at risk for uteroplacental insufficiency
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Non-stress test (NST) reactive
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"2 or more accels of 15 bpm lasting over 15 sec in a 20 minute period. Long-term variability of 10 or more bpm
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Non-reactive NST
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if doesn’t meet NST criteria after 40 minutes
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Contraction Stress test (CST)
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Fetal monitoring in conjunction with nipple stimulation or oxytocin administration
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Recommended weight gain in pregnancy, based on maternal BMI:
|
"Low (<18.5) 28-40 lbs.--Normal (18.5-24.9) 25-35 lbs.--High (25-29.9) 15-25 lbs.--Obese (>30) 11-20 lbs.--4 to 6 lbs a month to gain in weight during pregnancy.
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Obesity complication in preg.
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"Prematurity, Neural tube defect, Stillbirth, Macrosomia, Wound infection/dehiscence if c-section
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Prenatal vitamins (PNV)
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Higher in iron, calcium and folic acid, Lower in Vitamin A,
|
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Nagele's rule
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1st day of LMP, subtract 3 months, and add 7 days
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Fundal height
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measures the distance from the top of the symphysis pubis over the curve of the abdomen to the top of the uterine fundus. Correlates with weeks gestation. Ex 26cm=26 weeks gestation
|
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Quickening
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fetal movement felt by the mother indicates 20 weeks gestation or some btwn 16-22.
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Vibroacoustic Simulation (VAS)
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application of sound 90db for 1 to 3 secounds to stimulate fetal movement
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Biophysical Profile (BPP)
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FHR accleration(done with NST), (rest doen with ultrasound) fetal breathing, fetal movements, fetal tone, amniotic fluid volume. Also, (doppler flow studies and detect placental maturity= placental grading).
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2 most important parts of the BPP are…
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NST (reflect intactness of nervous system and AFI (reflects kidney perfusion)
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Placental maturity grade
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I - III , III being the most mature can be due to GD, postterm, preclampsia, etc.
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Chroionic Villus Sampling (CVS)
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used to detect genetic, metabolic, and DNA abnormalities. Can not detect NTDs can be done btwn 10 to 12 wks
|
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Percutaneous umbilical blood sampling (PUBS) or Cordocentesis
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Cordocentesis
gets pure fetal blood to dx blood disorders, anemia, infection, blood grouping, |
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Omega-3, DHA – essential fatty acids
|
"Good neurological development for fetus, Fish oil capsules or flaxseed oil capsules – 1000 mg a day, Expecta – OTC formula of DHA/EFA, Some PNV include these as part of the packaging (e.g. One-A-Day Prenatal Formula)
|
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Iodine
|
normal thyroid function and prevention of impaired brain development
|
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Sodium
|
for proper metabolism and fluid balance
|
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Magnesium
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for cellular metabolism and growth
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physiologic anemia of pregnancy
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nonpregnant women hmcrit is 38to 47%. When pregnant hematocrit can drop to 34%
|
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Vit A
|
Fat soluble V, aids in metabolism of carbs and fats, aids in growth os epithelial cells (skin and GI tract) and develops healthy eyes in fetus. High amounts of this V cause birth defects.
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Vit D
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Aids in absorption of calcium and phosphorus
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Vit E
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It is an antioxidant.
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Vit K
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is an essential factor for synthesis of prothrombin= related to normal blood clotting.
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Vit C
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Essential to the formation of collagen, overall aids in the development of connective tissue and the vascualr system,
|
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B vitamins (Folic Acid)
|
0.4mg pre-pregnancy, 0.6 during pregnancy, and 0.8
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Fluids
|
8 to 10 (8oz) glasses a day which 4 to 6 should be water
|
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Pattern of Weight Gain During Pregnancy
|
1st Trimester - 1.1- 2.2lbs, 2nd and 3rd Trimester based on weight
|
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Calculating BMI
|
WT(KG) DIVIDED BY HT(M2)
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Caffeine
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"Eliminate if possible, Vasoconstrictor, increase risk for miscarriage because limits blood flow to developing fetus, Limit to 300 mg daily if desired (one cup of coffee or one can of soda a day).
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Mercury
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"Limit fish intake to no more than 12 oz a week. Avoid swordfish, tile fish, king mackerel, large tuna steaks, shark. Fish oil capsules okay. Generally, salmon, shrimp okay; one 6 oz can of chunk light tuna (not albacore or white tuna) a week.
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Lacto-ovovegetarians
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include milk, dairy products, and eggs in diet
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Lactovegetarians
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include dairy but no eggs
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Vegans
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need to supplement with B12 vitamins
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Foods to avoid in pregnancy
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No raw meat, poultry, fish or eggs. No uncooked hot dogs or deli meats such as salami, prosciutto, pepperoni, smoked fish (canned smoked fish okay). No unpasteurized dairy or fruit juices. No soft cheeses that have been out of the refrigerator for longer than an hour.
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Alcohol in pregnancy
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Advise not to drink alcohol in pregnancy, because we have not been able to establish safety guidelines.
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Cultural foods
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generally not an issue, provided the foods follow the guidelines to avoid mercury and bacterial concerns.
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Exercise restrictions for pregnancy
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"Do not lift, push or pull more than 20-25 lbs. (harmful to mom), No excessive exertion or over-heating. No spinning classes or Bikram yoga. No hot tubs, saunas, jacuzzis or prolonged hot baths. ( Concerned about raising core body tempture that will affect fetus development). No activities requiring keen balance or coordination (e.g., skiing of any type; roller-blading, mountain biking) preg you are just clumsier!
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Maximum training heart rate for pregnant mother
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140 (or 160 if in good condition prior to pregnancy) because of less oxygen available to fetus.
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Max altitude for pregnancy
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8000 feet, Limit activities at elevations above 4000 feet no scuba diving
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Flying restrictions of pregnancy
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Flying is fine until 34 weeks because pressure changes can rupture amniotic sac. Move legs because of the blood clot risk due to the estrogen.
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Why heartburn in pregnancy?
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happens because of displacement of the stomach by enlarging uterus and the increase of progesterone decreases GI motility and relaxes esophageal sphincter.
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Tx for heartburn
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Avoid overeating, ingesting fatty and fried foods, and remain upright 30 minutes after eating. Drugs: Antacids (e.g., Tums, Rolaids, Mylanta, Maalox). H-2 blockers (e.g. Zantac 75 or Pepcid AC), Simethicone (e.g. Gas-X), Don't us Tagamat= why?
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Tx for constipation in pregnancy
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"Increase fluids (at least 2000ml/day), exercise, fiber in diet, & Stool softeners (docusate sodium, 1-2 times a day), Glycerine suppositories, or Milk of Magnesia if laxative needed
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Tx of itching, irritation
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"Lubricating skin creams (e.g., cocoa butter, Eucerin, Aquaphor), Benedryl cream for skin rashes
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Tx for acne
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"Facial washes containing salicylic acid (e.g. Neutrogena line), OTC Benzoyl peroxide, See Derm for topical antibiotics if needed. Can not use tetracycline's
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Skin tx prevention
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Wear sunscreen!!!
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Back, ligament and joint pain
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"Massage, heat (to the back, but not the abdomen), Chiropractic (those who are comfortable dealing with pregnancy), Carpal tunnel wrist braces, Maternity belt/girdle
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Varicose veins
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"Support hose, Maternity girdle
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Headaches
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"Pre-pregnancy migraines tend to improve in pregnancy, Acetaminophen 650 mg every 4 hours or 1000 mg every 6 hours. Add a caffeine source if needed. Massage to neck; heat or ice. NO ibuprofen or naproxen or aspirin products. NO migraine meds
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Normal fetal lie
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Longitudinal (vertica). Longitudinal= fetus spine is parallel to mom's spine.
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Normal attitude
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Back rounded, chin flexed on chest, thighs flexed on abdomen, legs flexed at knees, arms crossed over thorax, umbilical cord lies between arms and legs= General Flexion
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Ideal fetal position
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occiput anterior
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The presenting part of fetus O,S,M,Sc stands for what?
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Occiput, Sacrum, Mentum (chin), Scapula
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Engagement
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indicating that the largest transverse diameter of the presenting part (usually the biparietal diameter- BPD) has passed through the maternal pelvic brim or inlet into the true pelvis, and usually correlates with station 0
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When does engagement occur?
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"Can happen in several weeks prior to labor for a nullip. May occur before or during labor in a multip. Assessed by either abdominal or vaginal examination
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Role of soft tissues, lower uterine segment?
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distends and allows contractions and thickening of the upper uterine segment to push the intrauterine contents down toward the cervix
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Role of soft tissues, cervix?
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effaces (thins) and dilates (opens) to allow the first fetal portion to descend into the vagina, drawing up and over the first fetal portion
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Role of soft tissues, muscle layer of pelvic floor?
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helps fetus to rotate anteriorly
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Role of soft tissues, vaginal tissues
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develop during pregnancy to allow dilation at term, and permitting passage of the fetus
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Frequency
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time from beginning of one contraction to beginning of next
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Duration
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length of time of contraction
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Intensity
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strength of contraction
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Fundal Hieght
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Distance from the top of the symphysis pubis to the top of the uterine fundus
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Preparation for fundal height measurement
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-Have mom empty bladder
-Pillow under the knee and - Position mom-partially supine with knee flex |
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`Location of fundal height throughout gestation?
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-just over the symphysis pubis @ 12wks to 14wks
- at umbilicus @ 20wks - xiphoid process @ 36wks - drops 4cm by 40ks of gestation |
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What pregnancy risk factors can be assessed when measuring fundal height?
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Lo fundal Ht.: miscalculated due date, baby not growing, or small baby for term
Hi fundal Ht.:miscalculated due date, too much amonitic fluid, multiple births, or large baby for term |
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When is fundal height measured?
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16wks to 38wks
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What is the purpose of Leopold's Maneuvers?
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is done to determine the attitude, fetal presentation lie, presenting part, degree
of descent, an estimate of the size, and number of fetuses, position, fetal back & fetal heart tone; use palm! Warm palm. |
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Preparation for Leopold's Maneuvers?
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Empty bladder
Position of mom-supine with knee flex, and slightly to the side |
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Leopold's: 1st maneuver
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Place patient in supine position with knees slightly flexed; Put towel under head
and right hip; With both hands palpate upper abdomen and fundus. Assess size, shape, movement and firmness of the part. In dorsal recumbent position – to relax the abdominal muscles. To determine presentation parts. |
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Leopold's: 2nd maneuver
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with both hands moving down, identify the back of the fetus (to hear fetal heart
sound) where the ball of the stethoscope is placed to determine Fetal Heart Tone. Get Vital Signs (before 2nd maneuver) Pulse Rate to differentiate fundic soufflé (Fetal Heart Rate) & uterine soufflé (Maternal Heart Rate). To determine fetal back. |
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Leopold's: 3rd maneuver
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using the right hand, grasp the symphysis pubis part using thumb and fingers.
To determine degree of engagement. (Assess whether the presenting part is engaged in the pelvis ) Alert : if the head is engaged it will not be movable. |
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Leopold's: 4th maneuver
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the Examiner changes the position by facing the patient’s feet. With two hands,
assess the descent of the presenting part by locating the cephalic prominence or brow. When the brow is on the same side as the back, the head is extended. When the brow is on the same side as the small parts, the head will be flexed and vertex presenting. To determine attitude – relationship of fetus to 1 another. Attitude – refers to the relationship of fetus to each part into one another ( degree of flexion ) Full flexion – when the chin touches the chest |
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What does the Nonstress test determine?
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determines the response of the fetal heart rate to activity
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NST Procedure
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Done within 30 minutes wherein the mother is in semi-fowler’s position (w/ fetal
monitor);external monitor is applied to document fetal activity; mother activates the “mark button” on the electronic monitor when she feels fetal movement. |
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What is the prembroyic period?
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The 1st 2wks after conception
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What is a zygote?
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A fertilized ovum after the fourth day of conception
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What is a morula?
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A zygote that has divided into 16 cells (resembles a mulberry)
The outer cells secret fluids forming a blastocyst |
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What does the blastocyst form?
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The fetus (inner mass of cells) and the placenta and fetus membranes (outer mass of cells)
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Describe implantation?
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-occurs 6 to 9 days after fertilization
-occurs when the blastocyst implants itself in the endometrium of the anterior or posterior fundal region |
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What is the deciduas?
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The endometrial lining during pregnacy
- Sercetes prolactin, relaxin, and prostaglandin |
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Location of implantation? And 3 reasons why?
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Upper portion of the uterus more posterior than anterior.
1.rich supply of blood 2. thick muscular wall to prevent placenta from embedding to deep 3. Muscular tone limits blood loss after birth |
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What is the embryonic period?
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The 3wk to 8wk after conception
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What are the three germ layers and what do they form ?
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Ectoderm
Mesoderm Endoderm And they form the major organ systems of the body |
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What does the ectoderm form?
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Brain and Spinal Cord
Peripheral nervous system Pituitary gland Sensory epithelium of eye,ear, and nose |
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What does the Mesoderm form?
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Muscular skeletal system
Heart,blood cells and vessels Lymphatic system Endocrine Reproductive system |
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What does the endoderm?
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Lining of the GI and Respiratory tract
Tonsils Thyroid and Parathyroid Liver Panceras Lining of GU |
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Chorion
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where placenta is developed – outermost membrane of the fetal membrane
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Trophoblast
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fingerlike projections covering around the blastocyst that later becomes
placenta and membrane. |
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Amnion
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innermost layer of the fetal membrane. It is a membrane, continuous with and covering the fetal side of
the placenta that forms the outer surface of the umbilical cord. |
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Amniotic Fluid
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also known as (BOW) bag of water, clear, odor mousy/musty, with crystallized
forming pattern, slightly alkaline. |
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Function of Amniotic Fluid?
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1. cushions fetus against sudden blows or trauma
2. facilitates musculo - skeletal development and symmetrical growth 3. maintains temperature 4. prevent cord compression 5. help in delivery process |
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Normal amount of Amniotic Fluid?
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500 to 1000cc
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Fetal Period
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9wks to birth.
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Placenta Function
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1. Respiratory System – beginning of lung function after birth of baby.
2. GIT – transport center, glucose transport is facilitated diffusion more rapid from higher to lower. 3. Excretory System- artery - carries waste products. Liver detoxifies waste products of the fetus. 4. Circulating system – achieved by selective osmosis 5. Endocrine System – produces hormones |
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What is Placenta Previa
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it occurs when the placenta is improperly implanted in the lower uterine segment,
sometimes covering the cervical os. |
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S/S of Placenta Previa
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FRANKBRIGHT RED PLEEDING, PAINLESS BLEEDING
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Abruptio Placenta
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it is the premature separation of the placenta form the implantation site.
- It usually occurs after the twentieth week of pregnancy. |
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S/S of Abruptio Placenta
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dark red, painful bleeding
board like or rigid uterus/abdomen Severe abdominal pain |
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Placenta succenturiata
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1 or 2 more lobes connected to the placenta by a blood vessel
which may lead to retained placental fragments if vessel is cut |
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S/S of Placenta incerta
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deeper attachment of placenta to
myometrium |
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Difference in the placenta on the maternal and fetal sides?
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Fetal= smooth, with branching vessels covering the surface
Maternal= Rough it attaches to the uterus |
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Placenta Accreta
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unusual attachment to myometrium
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Problems with Retained Placental Fragments?
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Infection
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Teratogens-
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any drug, virus or irradiation, the exposure to such may cause damage to the fetus
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Types of Teratrogens?
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Streptomycin- Deafness
Tertacycline - inhibit growth of long bone Viamint K -hemolysis Iodides Steriods - Cleft Lip or plate Thalidomides- Amelia- no extremites Lithium - congenital extremities ETOH Smoking Caffeine Cocaine |
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Morning Sickness(1st) Nsg Intervention
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Eat dry carbohydrate in am; avoid fried,
odorous, and greasy foods; small meals rather than large; and a protein snack at nite |
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Fatigue(1st) Nsg Intervention
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Rest frequently, as needed.
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Urinary frequency (1st and late 3rd) Nsg intervention
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Kegel exercises, perineal pad for leakage.
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Heart Burn (2nd and 3rd) Nsg intervention
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Small meals, bland foods, antacids if ordered.
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Constipation (2nd and 3rd) Nsg intervention
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Sufficient fluids, foods high in roughage,
regular bowel habits. No laxatives unless ordered, including mineral oil. |
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Hemorrhoids (3rd) Nsg Intervention
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Avoid constipation; promote regular bowel
habits. |
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Hyperemesis Gravidarum Nsg intervention
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1. Begin NPO and IV fluid and electrolyte replacement. (Correction of
F&E balance will decrease nausea, NPO will rest the stomach) 2. Monitor I&O 3. Gradually re-introduce PO intake, monitor amounts taken and retained 4. Monitor TPN and central line placement if unable to eat. 5. Provide mouth care. |
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Hyperemesis Gravidarum Potential Problems
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Excess nausea and vomiting of early pregnancy leads to dehydration
and electrolyte disturbances, especially acidosis. |
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What is cotyledons?
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sections of the placenta
there should be 18-28 |
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Abruptio Placentae Nsg
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1. Ensure bed rest.
2. Check maternal/fetal vital signs frequently. 3. Prepare for IV infusions of fluids/blood as indicated. 4. Monitor urinary output. 5. Anticipate coagulation problems (DIC). 6. Provide support to parents as outlook for fetus is poor. 7. Prepare for emergency surgery as indicated. |
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Umbilical Cord
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Connecting link between fetus and placenta.
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Describe the umbilical Cord
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Contains two arteries and one vein supported by (Wharton's
jelly) to prevent kinking and knotting. |
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Direction of blood flow in the umbilical cord?
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Arteries- unoxgenated blood flow
Veins- oxygentated blood flow |
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Vilamentous Insertion of cord
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cord divides into small vessels before it enters the placenta
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Vasa Previa
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velamentous insertion of cord has implanted in cervical OS
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Battledore Placenta
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cord inserted marginally rather then centrally
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Cord Prolapse
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a complication when the umbilical cord falls or is washed through the cervix
into the vagina. |
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Danger Signs of Cord Prolapse
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* PROM (premature rupture of membrane )
* Presenting part has not yet engaged * Fetal distress * Protruding cord form vagina |
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Nursing Care of Cord Prolapse
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1. Slip cord away from presenting part
2. Count pulsation of cord for Fetal Heart Tone 3. Positioning – trendelenberg or knee chest position 4. Observe for fetal distress 5. provide emotional support 6. Prepare mother for Cesarean Section · Cover cord with sterile gauze with saline solution - to prevent drying of cord so cord will remain slippery. * NOTE: five minutes cord compression |
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Amniocentesis
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obtain a sample of amniotic fluid by inserting a needle through the abdomen
into the amniotic sac. |
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Amniocentesis preparation
|
empty bladder before performing the procedure.
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Amniocentesis fluid is tested for?
|
1. Genetic screening / abnormality - maternal serum alpha feto-protein test (MSAFP)
– 1 s t trimester 2. Determination of fetal lung maturity primarily by evaluating factors indicative of lung maturity – 3 rd trimester 2.1 Testing time – 36 weeks |
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Oxygenation consumption during pregnancy?
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RV increases 20 to 40 % to provide o2 for fetus, placenta, uterus, and breast and increased maternal respiratory and cardiac demands
Oxygen consumption increases by 15%. |
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Flow is maxminzed in what position during pregnancy?
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Blood flow to uterus and placenta is maximized by side-lying position.
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What causes acroesthia?
|
Pressure on sciatic nerve may occur later in pregnancy due to fetal
position. |
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Renal System changes during pregnancy?
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A. Kidney filtration rate increases as much as 50%.
B. Glucose threshold drops; sodium threshold rises. C. Water retention increases as pregnancy progresses. D. Enlarging uterus causes pressure on bladder resulting in frequency of urination, especially during first trimester; later in pregnancy relaxed ureters are displaced laterally, increasing possibility of stasis and infection. E. Presence of protein (not an expected component of maternal urine) indicates possible renal disease or pregnancy-induced hypertension. |
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Endocrine System changes during pregnancy?
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A. Pituitary: FSH and LH greatly decreased; oxytocin secreted during labor
and after delivery; prolactin responsible for initiation and continuation of lactation. B. Progesterone secreted by corpus luteum until formation of placenta. C. Principal source of estrogen is placenta, synthesized from fetal precursors. D. HCS/HPL produced by placenta; similar to growth hormone, it prepares breasts for lactation; also affects insulin/glucose metabolism. May overstress maternal pancreas. E. Ovaries secrete relaxin during pregnancy. F. Slight increase in thyroid activity and basal metabolic rate (BMR). G. Pancreas may be stressed due to complex interaction of glucose metabolism, HCS/HPL, and cortisol, resulting in diminished effectiveness of insulin, and demand for increased production. |