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multipara
2 mor more pregnancies >20 weeks
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lining of uterus
endometrium
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antepartum
period of pregnancy from conception to onset of labor
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intrapartum
labor through delivery of placenta
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post partum
6 weeks (8 if c-section) after childbirth / or until reproductive organs return to pre-pregancy state
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amenorrhea
absence of menstration
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embryo
3rd - 8 wek after conception
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fetus
9th (12th) week to birth
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Gestational age
prenatal age of developing baby calculated from first day of last menstrual period
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teratogen
- chemical / physical agent which interferes with critical embryonic / fetal development
- high temps / radiation / drugs / alcohol / cocaine / smoking / mercury / live firus vaccines
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zygote
cell formed by union of ovum and sperm
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abortion
spontanious or elective before 20th week gestation
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braxton hicks contractions
irregular usually mild contractions throughout pregnancy taht become stronger in last trimester
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chadwick's sign
bluish purple discoloration of cervix, vagina, and labia during pregnancy
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colostrum
breast fluid secreted during pregnacy and the 1st week after birth
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diastasis recti
seperationof longitudinal muscles of abdomen during pregnancy
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goodell's sign
softening of cervix during pregnancy
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gravida
number of pregnancies regardless of duration or outcome
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chloasma / melasma
"mask of pregnancy" brownish igment of face during pregnancy
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Para
number of pregnancies that have progressed to 20 weeks or more regardless of outcome (number of pregnancies not fetuses)
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Postterm birth
after 42 weeks
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preterm birth
after 20th week and before the start of 38th
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quickening
first movement of fetus in uterus felt by mother
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stria gravidarum
irregular pink/purple streaks on abd/breats/thighs resulting in tears from connective tissue
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Pica
ingestion of nonnutritive substances (laundry starch, clay, ice) may be sign of anemia
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amniocentesis
sample of amniotic fluid
- 1st tri - chromosomal abnormalities
- 3rd - lung maturity (surfactnant levels)
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AFP
16-18 weeks
- elevated - neural tube defects
- low- downs syndrome
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Chorionic villi samping
8-12 weeks genetic diagnosis
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Non-stress tess
Reactive response good (increase of 15bpm for 15 seconds)
Non-reactive Non-stress is Not good (3 negatives in a row to interpret results)
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Biophysical profile
- fetal heart rate variability
- fetal breathin movements
- gross body movements
- muscle tone
- amniotic fluid volume
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contraction stress test
evaluate fetal status while under stress from contraction
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Weight gain during pregnancy
- Normal weight (19.8-26) -total 25-35 lbs 3.5 lbs 1st trimester, 1lb/week 2nd&3rd
- Underweight (<19.8) -total 28-40 lbs 5 lbs 1st trimester, 1.1lb/week 2nd&3rd
- Overweight(26-29) -total 15-25 lbs 2 lbs 1st trimester, .7lb/week 2nd&3rd
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Protein
- 60g in pregnancy
- Happy (hamburger)
- To (tuna)
- Consume (chicken)
- My (milk)
- Calories (cottage cheese)
- Sanely (soy beans)
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Iron
- 30mg in pregnancy
- organ meats, red meats, green leafy vegetables, bran, sunflower seeds, legumes
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Folic Acid
400mcg
- take before becoming pregnant decrease risk for neuro tube defectbeans, OJ, green leafy vegetables, fortified foods (cereals/breads)
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Calcium
- 1300mg <18 y/o
- 1000 >18 y/o
dairy products, dried fruits, salmon & sardines w/ bones, broccolli, dark green leafy vegetables, peanuts, almonds, refried beans
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Foods to avoid during pregnancy
- alcohol
- caffine
- artificial sweeteners
- cholesterol
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Calorie increase in pregnancy
- no increase 1st trimester
- 300-400/day 2nd & 3rd trimester
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Presumptive signs of pregnancy
- amenorrrhea, breast sensitivity,
- uterine changes, fatigue, frequency, pigmentary changes, N&V, striae, constipation, weight gain, leukorrhea, quickening
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linea nigra
dark line midline on stomach, fades after pregnancy
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probable sings of pregnancy
lab test; ballottement; braxton hick's contractions; goodell's sign; hegar's sign; chadwick's sign
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positive sings of pregnancy
- fetal heart tones
- untrasound
- fetal movement felt by a primary care practitioner
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ballottement
sudden tap on the cervix during vaginal examination may cause the fetus to rise in the amniotic fluid and then rebound to its original position
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hegar's sign
compressibility of lower uterus - reflects softening of isthmus of cervix
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natural family planning
- calendar
- standard days
- basal body temperature
- cervical mucus
- symptothermal
- abstinence
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Implantation
- 7-10 days after fertilization
- trophoblast (exposed cell walls of blastocyysts) secretees enzyme which allows blastocysts to enter endometrium
may cause slight spotting
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organogenesis
- 2-8 weeks
- critical time in development (CNS, heart, extremities, eyes, palate, external genitalia)
- 3rd week resp/digestive tract 1 tract; 4th week septum begins
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12 weeks
- fetal heart tones auscaltated
- lower body develops
- kidenys produce urine
- uterus rises above pelvic rim
- risk for uti increases
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16 weeks
- looks more human
- meconium in bowel; anus opens
- heart well developed
- testes ready for descent / vagina opens
- fetal movement detectd by mom (16-20 weeks)
- colostrum may be expressed (small amounts)
- placenta is clearly defined
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20 weeks
- vernix
- lanugo
- sleeps, sucks, kicks
- fundus reaches level of umbilicus
- areola darken, colostrum
- postural hypotension
- pregnancy becomes "real"
- leg cramps (hypocalcemia)
- nasal stuffiness (saline spray no OTCs)
- varicose veins
- constipation
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24 weeks
- skin red & wrinkled
- blood formation increases in bone marrow & decreases in liver
- can hear
- uterus rises above umbilicus
- diastolic b/p gradually increases 24-32 weeks (returns to prepreg levels by term) / systolic remains same as pre-pregglucose testing between 24-28 weeks
- 1h (if failed then 3 hour)
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28 weeks
- can breathe, swallow, regulate temperature
- surfactant forms
- eyelids open
- greates period of weight gain
- fundus halfway betwen umbilicus/xyphoid
- fetal outline is palpable
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32 weeks
- brown fat deposit develop
- store iron, calcium, phosphorus
- fundus at xiphoid
- breasts are full/tender
- urinary frequency returns
- swollen ankles
- dyspnea
- sleep disturbances
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36-40 weeks
- occupies entire uterus
- maternal antibodies transfered to fetus
- lightening
- backaches increase
- braxton hicks intensifies
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Placenta
- Dirty Duncan - mother side (cotyledons) red rough surface (blood expulsion when presented first)
- shiny schultze - fetus side smooth & shiny (small gush of blood precedes placenta if presented first)
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Umbilical cord
- 20-22" long 1" round
- 2 arteries (deoxygenated to placenta)
- 1 vein (o2 to vetus)
- warton's jelly - prevents compression of blood vessels
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Amniotic fluid
- protects fetus in uterus
- 1000-1500ml at birth
- clear - yellow ish
- no smell
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Prenatal visit schedule
- q4 weeks conception -28 weeks
- q2 weeks 28-36 weeks
- every week 36-delivery
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Naegles rule
- first day of LMP
- - 3 months
- + 7 days
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GTPAL
- Gravida
- Term births
- Preterm births
- Abortions (loss before age of viability count to gravida not para)
- Living children
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Danger signs of pregnancy
- visual disturbances
- headaches
- edema
- rapid weight gain
- pain
- S&S of infection
- vaginal bleeding
- persistant vomiting
- muscular irritability / convulsions
- decreased fetal movement
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CABS
- C - chills & fever / cerebral disturbances
- A - abdominal pain
- B
- blurred vision / blood pressure / bleeding- S
- swelling / sudden escape of fluids
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Fundal Height
- indicator of fetal growth
- 18-30 weeeks fundal height = aprox gestational age in weeks
- may be indicator of high risk factors (UIGR, hydoramnios, multiple gestation)
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Fetal cardiovascular system
- ductus venosus - half blood bypasses liver & enters inferior vena cava
- ductus arteriosus- blood from L ventricle into aorta
- foramen ovale - R atrium into L atrium
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TORCH
- T - Toxoplasmosis (cat feces / undercooked meat)
- O
- Other viruses (5th disease / chickenpox / lyme disease / HIV / Hep B / Group B strep)- R
- Rubella- C
- Cytomegalvirus- H
- Herpes (& other STDs)
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Prenatal Lab tests
- Blood type / RH factor
- CBCD
- VDRL ( syphylis)
- Rubella titer
- Hep B
- HIV
- AFP
- GTT (glucose tolerance test)
- Strep B
- Cultures: gonorrhea/ chlamydia/ group b strep)
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