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Functions of amniotic fluid?
- Provides a medium for fetal movement
- Injury protection
- Temperature regulation
- Nourishment
- Prevents amnion from sticking to the fetus
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Functions of the umbilical cord?
- Connection between fetus and placenta
- *3 vessels;Artery, Vein, Artery
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Functions of the placenta?
- Respiration
- Nutrition
- Excretion
- Protection
- Storage
- Hormone production
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Major hormones of pregnancy?
- HCG: Human Chorionic Gonadotropin: Prevents involution of the corpus luteum –continuing production of estrogen/progesterone.
- Human Placental Lactogen: Causes changes in maternal metabolism to increase availability of glucose, protein, and minerals for the fetus.*Decreases maternal metabolism of glucose to support fetal growth.
- Estrogen: Proliferative function; increase in uterine size, breasts, & glandular tissue.
- Progesterone: Increases receptivity to implantation, reduces uterine contractility Relaxin: inhibits uterine activity, softens the cervix, & causes changes in connective tissue.
- Prostaglandins: Maintain reduced placental vascular resistance, may have a role in pre-eclampsia, labor onset.
- Prolactin: stimulates breast and milk production
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1st trimester (conception-12W)
- *Length: 8 cm crown – rump
- *Weight: 45 grams
- *Organs developed
- FHT – fetal heart tones doppler -10 weeks
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2nd trimester (13W-24W)
- *Length: 23 cm
- *Weight: 780 grams
- * Viability reached
- FHT: stethoscope – 14 weeks
- Fetal movement felt by examiner 20 weeks
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3rd trimester (27W-birth)
- *Length: 40-52 cm
- *Weight: 3200+
- *Complications related to prematurity decrease with greater gestational age
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Preconception education?
- Accurate Health History & Physical Exam: diagnosis and treatment of maternal disorders
- Teratogen
- Nutrition & Supplementation (Folic acid)
- timing conception
- Healthy life style choices
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Signs of pregnancy?
- Amenorrhea
- Urinary frequency
- Morning sickness
- Breast changes (tenderness)
- Skin pigmentation
- Quickening(movement of baby)
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Chadwick’s sign
* blue discoloration of cervix, vagina, & vulva
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*McDonald’s sign or Hegar’s sign
softening of lower uterine segment
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4 maternal tasks
- seeing safe passage
- securing acceptance
- Learning to give of herself and to receive the care and concern of others
- committing to child
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Discomforts of pregnancy?
- Fatigue
- Nasal stuffiness
- Nausea
- Heartburn
- Constipation
- Hemorrhoids
- Vaginal discharge
- Backache
- Varicose veins
- Leg cramps
- Edema of the lower extremities
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Reproductive changes?
- Uterus: Temp. abd. organ, 5000cc capacity
- Cervix: mucous plug forms prevention of organisms from entering uterus
- Ovaries: Produce progesterone to maintain uterine lining
- Vagina: Increased blood supply (bluish), PH more acidic, High glycogen level=candida albicans
- Breasts: Hormones prepare for lactation
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Colostrum
*premilk” is* high in protein, fat-soluble vitamins, and minerals
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Respiratory system changes?
- O2 consumption increase 15%
- Diaphragm rises (4cm)
- Dyspnea may occur until fetus descends into pelvis
- Increased estrogen can cause edema of upper airways
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Cardiovascular changes?
- Blood volume increase 45%: *Exchange of nutrients, oxygen, and waste products within the placenta*Needs of expanded maternal tissue*Reserve for blood loss at birth
- Pulse increase 10-15 BPM
- Orthostatic hypo-tension may occur
- palpitations possible
- dilutional anemia
- clotting factors increase in 2nd/3rd trimester
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GI changes?
- Displacement of stomach and intestine
- Increased estrogen=increase glandular secretions
- increased appetite/thirst
- decreased gastric acid secretion
- delayed gastric emptying-increased gastric reflux
- progesterone and estrogen relax muscle tone of gallbladder=retained bile salts leading to possible pruritus
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GU changes?
- excretion of fetus and women wastes
- *Glomerular filtration rate of kidneys increases
- *Glycosuria and proteinuria more common
- Water retention
- more susceptible to UTI
- Due to hormones-99% of sodium reabsorbed Urinary stasis
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Integ/Skeletal changes?
- Spider nevi
- sweat and sebaceous glands increase production
- posture changes-low back ache
- relaxation of pelvic joints
- waddling gaits
- change in center of gravity
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Nagels rule?
- First day of LMP
- Subtract 3 months
- Add 7
- Add one year=EDD
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GTPAL system
- G: Total number of pregnancies
- T: babies born at term (> 37 weeks)
- P: babies born preterm (<37 weeks)
- A: number of pregnancies ending in spontaneous or therapeutic abortion (prior to 20 weeks gestation)
- L: number of children currently living
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Gravida
Number of pregnancies
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Prenatal care?
- *Ongoing care
- *Vital signs
- *Weight
- *Urinalysis
- *Uterine growth
- *Fetal heart rate
- *Current health complaints
- *Education
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Prenatal schedule?
- *One office visit/month until 32 weeks*
- *2 visits/month from 32-37 weeks*
- *1 visit/week from 37 weeks to EDD*
- *Postdates – 2 visits/week
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Recommended weight for pregnancy
- *Women of normal weight: 25 to 35 pounds (11.5 to 16 kg)
- *Underweight women: 28 to 40 pounds (12.6 to 18 kg)
- *Overweight women: 15 to 25 pounds (7 to 11.5 kg)
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Pregnancy warning signs?
- *Vaginal bleeding
- *Swelling of face and hands
- *Continuous headache
- *Vision changes- dimness, blurring, flashes of light
- *Persistent vomiting
- *Abdominal pain
- *Chills/fever
- *Sudden leaking of fluid from the vagina
- *Decreased fetal movement
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common teratogens?
- Timing of exposure
- duration of exposure
- amount of exposure
- genetics
(Smoking, alcohol, caffeine, cocaine, meth) some herbal supplements
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Drug classifications for prego
- A: shows no risk to fetus
- B: no evidence of risk to humans
- C: risk cannot be ruled out
- D: positive evidence of risk
- X: shows risk and positive teratogenic effects on fetus.
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Antibiotics/antipyretics with known teratogenesis
- Tetracycline
- Streptomycin
- Chloramphenicol
- ASA/Salicylates
- NSAIDS
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Safest antibiotics or antipyretics
- Acetaminophen
- Penicillin & Erythromycin
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Chorionic villus sampling (CVS)
Testing for birth defects and genetic abnormalities
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Pitocin
used to induce labor
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