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What are the daily nutritional requirements for pregnancy?
- Protien 3xs, B12,
- Carbs 6xs, dairy 4x, fruit 2x, veggies 3x, green/deep yellow (vitamin C), Vitamin D, and Folic acid
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1. What is normal weight gain for pregnancy?
2. What should you gain in the 1st 20 weeks?
3. What should you gain after 20 weeks?
- 1. 25-35 lbs
- 2. 10-13 lbs
- 3. 1lb per week
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What is the break down of the weight gain?
- 11lbs- fetus, placenta, amniotic fluid
- 2 lbs- placenta
- 4 lbs- blood volume
- 3 lbs- breast tissue
- 5-10lbs of extra fat
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What is PICA?
Abnormal craving- dirt, laundry soap, corn starch etc
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What kind of meds are ok for Mom to take during pregnancy?
- Only prenatal vitamins
- Mom should medication free as possible!
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What is a teratogenic effect?
Anything that can cause a physiological abnormalities in the fetus.
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What does smoking, alcohol, and caffeine do to the fetus? (teratogenic effects)
- Smoking- vasoconstrictor, no blood supply, usually preemie, will have intrauterine growth restriction (IUGR)
- No caffeine- CNS stimulant- low birth weight
- Alcohol- the only preventable problem- physical defects, congenital defects, increased cognitive impairment, premature, placenta detaches, NICU
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How much folic acid should a pregnant woman take each day?
How many months ahead of conception?
What birth defects happen if a woman is deficient?
- 400 mcg/day
- Take 3 months ahead of time,
- Prevents spinal bifida which is the failure for the spinal cord to seal together, the lower the sac comes out the more severe,
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What does estrogen do?
stimulates uterine development to provide environment for fetal growth
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What does HUMAN CHORIONIC GONADTROPIN (HCG) do?
- Produced by the placenta
- What is detected in a urine pregnancy test
- Beta HCG (the acutal amount of HCG circulating in your blood)- if suspected bleeding- bed rest- watch to make sure levels go higher and higher
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What does HUMAN PLACENTAL LACTOGEN (HPL) do?
- promotes lipolysis
- Increases the resistance to insulin, facilitates glucose transport across the placenta
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What does progesterone do?
- maintains the endometrium and inhibits uterine contractions
- If low, can’t get pregnant
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What does PROSTAGLANDIN (lipids) do?
- associated with the onset of labor
- High concentration in pregnancy
- HTN in 1st trimester is related to prostaglandins
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What does RELAXIN do?
- In the beginning inhibits contractions
- Near the end of pregnancy softens the cervix
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What are the physiologic changes with the cardiovascular system in pregnancy?
- -Physiologic anemia (plasma volume increases 50% = 7% decrease in hematocrit)
- More plasma but RBCs are not able to produce as fast
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What is Vena cava syndrome?
- Or called supine hypotension syndrome
- Placenta compresses the vena cava
- **LAY ON LEFT SIDE- w/ pillows, if baby doesn’t like lay on right side
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What are the changes in the Cardiovascular system?
- Cardiac output 30-40%
- Increase of 10-15 beats per minute is normal
- Postural hypotension- uterus presses on pelvic & femoral arteries
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What are the physiologic changes with the RESPIRATORY system in pregnancy?
- Nasopharyngeal edema
- -Upper respiratory tract becomes more vascular in response to increased estrogen
- -Capillaries become engorged- lead to edema in pharynx
- -Will have stuffy nose- normal- mild upper respiratory infection (URI)
- Shortness of breath
- -Hyperventilation – lower threshold for carbon dioxide – this is a change in the respiratory center in the brain – is caused by progesterone and estrogen
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What are the physiologic changes with the RENAL system in pregnancy?
- If kidneys are not filtering will have gestational diabetes
- 7-10 years down the road the mother will have diabetes
- GFR ↑ 50% til delivery
- Urinary frequency
- 1st Trimester: Uterus presses on bladder = urinary frequency
- 2nd Trimester: Relieved by uterus moving into abdominal area
- 3rd Trimester: Urinary frequency as the presenting part presses on the bladder
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What are the physiologic changes with the GASTROINTESTINAL system in pregnancy?
- · Hyperptyalism- ↑ saliva because of estrogen
- · Pyrosis / Heartburn- Gas, constipation
- · Decreased gastric motility
- · Nausea and vomiting- Caused by HCG- 1st trimester & higher progesterone levels
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What are the physiologic changes with the INTEGUMENTARY system in pregnancy?
- Increased pigmentation- ↑ estrogen, darken nipples
- Striae gravidarum- stretch marks- ↑ adrenal & steroids levels, ↑ estrogen
- Linea negra- Dark line- from ↑ estrogen
- Chloasma- Mask of pregnancy- forehead cheeks- (birth control can also cause??)
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What are the physiologic changes with the MUSCULOSKELETAL system in pregnancy?
- Lordosis
- Carpal Tunnel Syndrome- ↑ fluid volume and edema
- Diastasis Recti- Sitting to standing- separation of rectus abdomen muscle because uterus enlarges
- Softening of pelvic ligaments and joints as pregnancy progresses because of relaxin
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What are the physiologic changes with the ENDOCRINE system in pregnancy?
- Thyroid gland- enlarges and increase metabolic rate
- Parathyroid- Makes you use Ca+ and Vitamin D better
- Pancreas- 1st trimester- ↓ ability to use glucose so baby can use it
- Pituitary gland- Prolactin- prepares body for lactation
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What are the physiologic changes with the UTERUS in pregnancy?
- 12th week can palpate the fundus
- Lightening- Dissention of the fetal head into pelvis
- Hegar’s Sign- Softening lower uterine segment (6-8 weeks)
- Braxton Hicks Contractions- False labor, uterus tightening and practicing
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What is Hegar's sign?
Softening lower uterine segment (6-8 weeks)
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What are the physiologic changes with the CERVIX during pregnancy?
- Goodell’s Sign- Softening of the cervix
- Mucus Plug- Acts as a barrier to from outside pathogens (estrogen), Endocervical canal mucus plug
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What is Goodell's sign?
Softening of the cervix, occurs in the 2nd month of pregnancy
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What are the physiologic changes with the VAGINA during pregnancy?
- Chadwick’s Sign- 6-8 weeks vaginal walls and cervix change color from pink to blueish/purple color
- Increase in vaginal discharge- White is normal- more acidic
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What is Chadwick's sign?
At 6-8 weeks vaginal walls and cervix change color from pink to blueish/purple color
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What are the physiologic changes with the BREASTS during pregnancy?
Fullness, tingling, tenderness, darkened areola, prominent blue veins, secretion of colostrum by 16th week
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What are the Psychological changes in the first trimester?
- FIRST TRIMESTER (1-12 weeks)
- Acceptance
- Announcement- tell other they are pregnant
- Ambivalence- financial worries, etc
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What are the Psychological changes in the second trimester?
- SECOND TRIMESTER (13-24 weeks) Differentiation
- Fetal embodiment- accept baby
- Visualization
- Quickening- 16-30 weeks can feel fetal movement
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What are the Psychological changes in the 3rd trimester?
- THIRD TRIMESTER (25-40 weeks)- mom become self absorbed? Separation of baby
- Concerned with safe delivery
- Childbirth education
- Nesting- Finding clothes, decorating baby’s room, diapers etc
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What is Couvade?
Syndrome which the husband shares cravings, weight gain, etc with his wife
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What are the PRESUMPTIVE (subjective) signs of pregnancy?
- “findings reported by the mother that suggest presence of a pregnancy”
- No period, N/V, fatigue, breast changes
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What is a molar pregnancy?
The cells multiply but have no heart beat, but gives off the same hormones as if you were pregnant
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What are the PROBABLE (objective) signs of pregnancy?
- “findings noted by a healthcare provider that suggest a pregnancy is present”
- Softening of the cervix, Hagar, Chadwick signs, enlarged abdomen, changes in pigmentation
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What are the POSITIVE (diagnostic) signs of pregnancy?
- “findings that confirm pregnancy”
- Fetal heart tones, normal fetal heart rate 110-160, fetal movement
- Quickening (mother feeling the baby move)
- HCP can feel uterus at 16-20 weeks just above the pubic bone
- Ultrasound
- o 5-6 weeks can see sac
- o 8 weeks can see brain and heart
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What are the warning signs of pregnancy?
- Bleeding, bright red blood
- Decreased fetal movements
- Headache
- o HA & visual changes,= increased BP Edema of hands and face
- Visual changes- Fireworks seen, keep blinking eyes, otomata??
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What are the signs and symptoms of a placenta abruptio?
- As early separation from uterus in 2-3 trimester
- **Lots of pain & cramping suddenly- emergency C-section
- Seperation of placenta from uterine wall
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What are the signs and symptoms of placenta previa?
- Placenta is in the lower uterine wall
- Dx by ultrasound
- ***Painless vaginal bleeding
- Hemmorrhage may happen even if the fundus is contracted firmly
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What are the signs and symptoms of INFECTION?
- UTI, abdominal or CP, chills fever, vomiting,
- hyperemesis gravtium- unable to stop vomiting
- ↑ fluid from vagina, constant leaking maybe possible ruptured membranes
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What is Nagele's Rule?
- 1st day of last menstrual period, go back 3 months and add 7 days.
- Exp: LMP 11/7/10 Due : 8/14/11
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What is gravida?
# of times pregnant
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What is parity?
# of infants delivered after 20 weeks (whether they were alive or dead)
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What does FPAL stand for?
- F- Full term
- P- preemies
- A- abortions
- L- living children
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What is important when looking for past medical history?
- Last Pap smear, STDs, more babies= ↑ risk of hemorrhage
- Chromosomal abnormalities
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What initial labs are done when pregnancy is confirmed?
- H&H / WBC
- Blood Type and Cross / RH
- Rubella
- VDRL- syphilis and gonorrhea
- GC - syphilis and gonorrhea
- HBsAg (antibody titer for Rubella / Hep. B)
- MSAFP (16-18 weeks)
- o Maternal serum alpha protein- looks for genetic defects
- Diabetes screen (24-28 weeks)
- o 24-28 weeks
- 1st glucose test – 1hr test- if failed have to take the 3 hour test
- HIV
- Genetic Screening
- o Sickle cell, Thalassemia- genetic blood disorder of misshaped RBCs
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What does TORCH stand for?
- T- Toxoplsmosis
- O- other infections
- R- Rubella
- C- Cytomegalovirus (CMV)
- H- Herpes Simples
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What is Toxoplasmosis caused by?
What can it cause?
- Improperly cooked meats or cat feces
- Cause fetal brain damage and high incident of abortions in 1st trimester
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What are the "Other" infections?
- HIV/Hepatitis/GBS/Syphillis/Varicella
- Group B streptococcus- pregnancy can aggravate it and Mom will test positive Will do 2-3 rounds of ABX before birth of infant
- Will cause pneumonia in neonate
- If Strep B is unknown- will get 1 round of ABX and infant will go to NICU for observation
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What does CYTOMEGALOVIRUS (CMV) cause in the fetus?
Mentally challenged, auditory impairment
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What will happen if the Mom has active herpes?
Dr will only deliver vaginally if Mom doesn’t have active herpes, if there is a lesion Mom will have a C-section
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How early can you do a ultrasound?
What does it confirm?
- 5 weeks
- confirm pregnancy and gestational age
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What is CVS -Chorionic Villus Sampling?
When do you do it?
- Take a sample of the fetal part of the placenta, checks for Down syndrome, sickle cell, muscular dystrophy- (unable to get up at age 2 with all 4 limbs)
- 10-12 weeks gestation
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1. What does Amniocentesis measure?
2. How is it done?
3. What is it checking for?
4. When is it usually done?
- 1. L/S ratio- 2:1 (lecithin/sphingomyelin)
- 2. Remove amniotic fluid by needle
- 3. Checking for fetal lung development, especially in large babies
- 4. 14-16 weeks gestation, >30 weeks gestation
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1. What is MSAFP - Maternal Serum Alpha Fetal Protein testing for?
2. How many weeks?
- 1. Checking for Neural Tube Defects (NTD) & Down Syndrome
- Blood draw from Mom
- 2. 16-18 weeks gestation
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1. Why is PUBS - Percutaneous Umbilical Blood Sampling done?
2. Where is the blood drawn from?
- 1. Transfusion and Fetal blood sampling (looking for abnormalities such as inherited blood disorders, detecting fetal infection, acid-base balance of fetus' with IUGR)
- 2. Blood draw from the umbilical cord
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1. When is a BPP - Biophysical Profile usually done and what is it looking for?
2. What are the categories?
3. What is normal? Equivocal? Abnormal?
- 1. Noninvasive assessment of the fetus and its environment using ultrasound and fetal
- 2.
- Fetal breathing movements
- Gross body movements
- Fetal tone (extension and flexion of arms, legs, and hands)
- Reactive fetal heart rate
- Qualitative amniotic fluid volume
- 3. Normal is 8-10
- Equivocal 6
- Abnormal <4
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What does the CST - Contraction Stress Test look for?
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o Test to stimulate uterine contractions for the purpose of assessing fetal response, a healthy fetus does not react to contractions, whereas a compromised fetus shows a late decelerations in the fetal heart rate that are indicative of uteroplacental insufficiency.
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