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Day 1 of cycle
- First day of menses (bleeding)
- Ovulation on Day 14
- 28 days total
- Sperm 3-5 days, Eggs 24 hrs
- Fertilization in Fallopian Tube
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Chadwick’s Sign
Bluing of Vagina (early as 4 weeks)
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Hegar’s Sign
Softening of isthmus of cervix (8 weeks)
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Goodell’s Sign
Softening of Cervix (8 weeks)
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Pregnancy Total wt gain
25-30 lbs (11-14 kg)
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Increase calorie intake by
- 300 calories/day during PG
- Increase protein 30 g/day
- Increase iron, Ca++, Folic Acid, A & C
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Dangerous Infections with PG
TORCH = Toxoplasmosis, other, Rubella, Cytomegalovirus, HPV
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Braxton Hicks
common throughout PG
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Amniotic fluid
- 800-1200mL
- (< 300 mL = Oligohydramnios = fetal kidney problems)
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Polyhydramnios and Macrosomia
(large fetus) with Diabetes
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Umbelical cord
- 2 arteries, 1 vein
- Vein carries oxygenated blood to fetus (opposite of normal)
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Folic Acid Deficiency
Neural tube defects
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TPAL
Term births, Pre-term births, Abortions, Living children
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Gravida
# of pregnancies regardless of outcome
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Para
# of Deliveries (not kids) after 20 weeks gestation
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Nagale's rule
add 7 days to first day of last period, subtract 3 months, add 12 months = EDC
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Hgb and Hct a bit lower during PG due to
hyperhydration
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best position for uteroplacental perfusion
Side-lying (either side tho left is traditional )
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2:1 Lecithin:Sphingomyelin Ratio
Fetal lungs mature
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AFP in amniotic fluid
possible neural tube defect
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for Amniocentesis early in PG
Need a full bladder (but not in later PG)
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Lightening
Fetus drops into true pelvis
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Nesting instinct
burst of energy just before labor
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true labor
regular contractions that intensify with ambulation, LBP that radiates to abdomen, progressive dilation and effacement
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station
negative above ischial spines, positive below
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leopold maneuver
tries to reposition fetus for delivery
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laboring maternal VS
- p <100 (usually a little higher than normal with PG; BP is unchanged in PG)
- t <100.4
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non-stress test
Reactive= Healthy (FHR goes up with movements)
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Contraction Stress Test (Ocytocin Challenge Test)
- Unhealthy = Late decels noted (positive result) indicative of UPI
- “Negative” result = No late decels noted (good result)
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watch for hyporeflexia with Mag Sulfate admin
diaphragmatic inhibition
keep calcium gluconate by the bed (antidote)
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early decels
head compression = ok
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variable decels
cord compression = not good
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late decels
utero-placental insufficiency = BAD!!
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if variable or late decels
- change maternal position
- stop pitocin
- administer 02
- notify physician
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DIC
- tx is with heparin (safe in pg)
- fetal demise, abruptio placenta, infection
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fundus 12-14 weeks
at level of symphysis
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fundus 20 weeks
20 cm = level of umbilicus
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fundus rises
~1 cm per week
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labor stage 1
beginning of regular contraction to full dilation and effacement
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labor stage 2
10 cm dilation to delivery
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labor stage 3
delivery of placenta
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labor stage 4
1-4 hours following delivery
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placenta separation
- Lengthening of cord outside vagina, gush of blood, full feeling in vagina
- Give oxytocin after placenta is out, NOT BEFORE
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Postpartum VS Schedule
Every 15 min X 1 hr
Every 30 min X next 2 hours
Every Hour X next 2-6 hours
Then every 4 hours
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lochia
- no more than 4-8 pads/day and no clots >1cm
- fleshy smell is normal
- foul smell = infection
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massage boggy uterus
- to encourage involution
- empty bladder ASAP - may need to cath
- full bladder can lead to uterine atony and hemorrhage
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tears
- 1st Degree = Dermis,
- 2nd Degree = mm/fascia,
- 3rd Degree = anal sphincter,
- 4th Degree = rectum
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