M/B Unit 1

  1. Autonomy
    the right to self determination
  2. Respect for others
    all persons equally valued
  3. Beneficence
    Obligation to do good
  4. Nonmaleficence
    Do no harm
  5. Justice
    equal and fair treatment of others
  6. Fidelity/Faithfulness
    obligation to keep promises
  7. Veracity
    obligation to tell the truth
  8. Utility
    the greatest good for the individual
  9. Amniotic fluid
    • by full term should be 800-1200 cc
    • 1st trimester produced by amniotic membrane, 2 & 3rd by fetal kidneys
    • Purpose is to protect fetus from pressure or blows, thermal regulation, aids in muscular development by allowing movement, protects umbilical cord
  10. hydramnios
    • too much amniotic fluid
    • 1500-2000 cc
  11. oligohydramnios
    • Less than 500cc amniotic fluid at term
    • often due to fetal kidney issues or decrease in placental function
  12. Placenta
    • maternal "decidua" (term for uterine lining)
    • fetal- chorionic villi
    • Nutrients and O2 are exchanged, fully functional at 12 weeks
    • Some harmful substances can't cross, some can
    • Secretes hormones
    • MATERNAL AND FETAL BLOOD DON'T MIX
  13. Amniotic membrane
    • Actually 2 membranes:
    • Chorionic membrane - outermost fetal membrane
    • Amniotic membrane - closest to fetus
    • so adherent, seems like one
  14. amnion
    • also called amniotic membrane
    • Produces amniotic fluid and phospholipid that forms prostaglandins
    • May be part of trigger for labor
  15. umbilical cord
    • connects fetus to placenta
    • has 1 vein that carries oxygenated blood to fetus
    • has 2 arteries that carry deoxygenated blood back to mom
    • usually inserted in center of placenta
    • vessels surrounded by Wharton's jely
  16. Whartons jelly
    • surrounds vessels in umbilical cord
    • prevents cord from collapsing
  17. Presumptive s/s of pregnancy
    • amenorrhea
    • breast changes
    • N/V
    • uterine enlargement
    • frequency urination
    • quickening
    • fatigue
  18. Probable s/s of preganancy
    • basal body temp elevated
    • ballottement
    • Ultrasound (sonographic)
    • serum lab test
    • urine home test
    • changes in skin & mucus: Chadwicks sign, Goodell's sign, Hegar's Sing, Linea nigra
  19. ballottement
    a sharp upward pushing against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling the return impact of the displaced fetus
  20. ONLY positive s/s of prego
    • ultrasound visualization - p 4 weeks
    • Fetal heart sounds - 10 - 12 weeks
    • Fetal movement felt by examiner
  21. amenorrhea
    lack of menstration
  22. quickening
    fetal movement
  23. chadwicks sign
    • color change in vagina and cervix
    • more bluish
  24. Goodell's sign
    softening of cervix
  25. Hegar's sign
    softening of lower uterine segment
  26. EDD
    • Estimated date of delivery
    • Naegele's rule:
    • count back 3 months from first day of last menstrual period, then add 7 days
  27. Para
    number of pregnancies that reached viability, regardless whether infants were born alive or not
  28. viability
    pregnancy that reaches 20 weeks
  29. gravida
    woman who is or has been pregnant
  30. primigravida
    woman who is pregnant for first time
  31. primipara
    woman who has given birth to 1 child past age of viability
  32. multigravida
    woman who has been pregnant previously
  33. Nullipara
    woman who has never been and is not pregnant
  34. chloasma
    • also called melasma
    • tan or dark skin discoloration, usually on cheeks, upper lip, chin and forehead
    • "Butterfly mask"
  35. diastasis rectus
    separation of stomach muscles
  36. couvade syndrome
    syndrome in which father also experiences N/V, weight gain, increased frequency to pee
  37. mcdonalds rule
    • also called fundal height
    • measure of size of uterus, used to assess fetal growth and development
    • measured from top of uterus to top of pubic symphysis
    • roughly corresponds to gestational age, 1 cm per week btwn 20 and 31 weeks
  38. doppler umbilical flow studies
    assessing for placental sufficiency
  39. amniocentesis
    • taken btwn 14 and 20 weeks
    • tests for chromosomal defects
  40. fetoscopy
    inspection through tiny tube inserted by amniocentesis for biopsy, some surgery
  41. NST
    • Non-stress test
    • 2 accelerations of 15 bpm x 15 sec in 20 mins
    • screening tool that uses electronic fetal monitoring to assess fetal well-being
  42. absolutely NO sex if:
    • bleeding
    • preterm labor
    • rupture
  43. preterm labor
    the presence of regular contractions, at intervals of 10 mins of < 1 hr, WITH CERVICAL CHANGE, and/or rupture of membranes after 20 weeks and before 37
  44. miscarriage
    if baby is lost before 20 weeks
  45. decidua
    thick layer of modified mucus membrane that lines the uterus during pregnancy and is she with afterbirth
  46. tocalytics
    meds given to try and stop labor
  47. bethamethazone
    if baby comes before 34 weeks, given to baby to help lungs
  48. clonus
    when you flex mom's ankles, the feet don't just smoothly relax back - will beat back
  49. Incompetent cervix
    • causes spontaneous abortions
    • Due to: trauma, anatomical abnormalities, Diethylstilbestrol taken by mother, infections, inflammation, or hormonal effects
    • Treatment is cerclage, if cervix is 3cm or les and membranes are intact
  50. mag sulfate
    • is a smooth muscle relaxant
    • given so mom doesn't seize (in HTN)
    • Also given in preterm labor to help stop labor
  51. Cervical cerclage
    • Treatment for incompetent cervix
    • Type of purse string suture placed cervically to reinforce a weak cervix
    • *If she starts contracting, must be undone or she will rip
  52. Chorioamnionitis
    • also known as intra-amniotic infection
    • is an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection.
    • It typically results from bacteria ascending into the uterus from the vagina and is most often associated with prolonged labor.
  53. corpus luteum
    a hormone-secreting structure that develops in an ovary after an ovum has been discharged but degenerates after a few days unless pregnancy has begun.
  54. Cotyledons
    • the cotyledons are the approximately 15-25 separations or sections of the decidua basalis of the placenta, separated by placental septa.
    • Each cotyledon consists of a main stem of a chorionic villus as well as its branches and subbranches etc.
    • Think of little trees in each space...
  55. What are TORCH infections and how are they detected
    • Toxoplasmosis
    • Other (Heb B)
    • Rubella
    • Cytomegalovirus
    • Herpes

    Detected from TORCH blood screen
  56. Toxoplasmosis: what is it, prevention and how is it treated
    • Single celled parasite; transplacental transmission
    • Done by blood screen
    • *AVOID raw meat and contact with cat feces
    • Tx: sulfadiazine or pyrimethamine after 1st trimester
  57. Toxoplasmosis: Effects on mom
    often asymptomatic but can cause fatigue, muscle pain, pneumonitis, myocarditis, lymphadenopathy
  58. Toxoplasmosis: effects on baby
    • severity varies with gestational age.
    • Can lead to:
    • spontaneous abortion
    • low birth weight
    • hepatosplenomegaly
    • anemia
    • neurological disease
  59. "Other" infections - Hep B: Treatment and prevention
    Transmitted direct w blood/body fluid

    • Infant receives HBIG (Human B Immune Globulin) and Hep vaccine at delivery
    • Screening recommended in prego

    HBV can be given in preganancy
  60. Other - Hep B: effects on mom
    • almost half are asymptomatic
    • Other have low fever, nausea, preterm labor/delivery
  61. Other - Hep B: effects on baby
    • have 90% chance becoming chronically infected, HBV carrier,
    • 25% risk developing liver disease
  62. Rubella: what is is, prevention and treatment
    German measles, Transplacental

    • Tx: primary approach is immunization.
    • If woman is prego & no immun, should NOT receive vaccine until after delivery and advised not to get pregnant for 3 mons
  63. Rubella: effects on mom
    • Rash
    • Lymph node enlargement
    • slight fever
    • HA and malasie
    • Just don't feel well
  64. Rubella: effects on baby
    • Anomalies include:
    • Deafness
    • eye defects
    • CNA anomalies
    • severe cardiac malformations
  65. Cytomegalovirus
    • Type of herpes infection
    • Transmitted by droplet or transplacentally

    May result in low birth weight, IUGR, hearing impairment microcephaly, and CNS abnormalities

    No treatment available
  66. HSV
    • Herpes Simplex Virus
    • Chronic lifelong infection; contact at delivery & ascending infection
    • Mom: painful genital lesions, which may be external or internal
    • Baby: Mortality of 50-60% if neonatal exposure to active primary lesion related to neuro complication of massive infection sepsis and neuro complications
    • NO CURE
    • C-section will protect neonate from exposure if active lesion
  67. Ductus arteriosus
    In the developing fetus, the ductus arteriosus, also called the ductus Botalli, is a blood vessel connecting the pulmonary artery to the proximal descending aorta.
  68. Ductus venosus
    • shunts a portion of the left umbilical vein blood flow directly to the inferior vena cava.
    • it allows oxygenated blood from the placenta to bypass the liver
  69. Ectopic pregnancy
    • Pregnancy outside of uterus - 95% in tubes
    • Higher with STD, tubal surgeries, prev ectopic prego, endometriosis, altered hormones, contraceptive failure from intra-uterine devices, smoking
  70. embryo
    term used for developing human from time of implantation through 8 weeks of gestation
  71. Fertilization
    the fusion of gametes to initiate the development of a new individual organism.
  72. fetus
    term used for developing human from 9 weeks gestation to birth
  73. Foramen ovale
    • Structure in fetal circulation
    • is an opening btwn right and left atria
    • blood high in oxygen is shunted to left atrium via the foramen ovale
  74. implantation
    embedding of the blastocyst into the endometrium of the uterus
  75. Lightening
    • term used to describe the descent of the fetus into the true pelvis
    • occurs approx 2 weeks before term in first-time pregnancies
  76. pelvic rocking
    used by women in labour to help them focus during contractions and it can assist with moving the baby down the birth canal.
  77. Progesterone
    • smooth muscle relaxant
    • preparing breasts for lactation
    • inhibiting uterine contractility
  78. Pyrosis
    heartburn
  79. What can you teach client about teenage pregancy
    • Decreased ability for mom to complete school
    • Increased risk of HTN in preo
    • 64% teen moms live in poverty
    • Increase risk for STD
    • Increased risk for baby health issues: prematurity, low birth weight, respiratory distress
    • Kids of teens increase interaction with law
    • Teen birth rate in US decreasing, but still higher than other countries
    • 25% of teen moms will have 2nd child within 24 months
  80. Current societal and physical risk factors for preg women
    • Smoking (causes preterm delivery, LBW and stillbirth)
    • substance abuse
    • Obesity (BMI >30)
    • preeclampsia
    • gestational diabetes
    • wound infection
    • economic status
    • age
    • race
    • ethnicity
  81. OB/GYN providers operate in high malpractice insurance premiums. Why?
    • Majority if injuries/legal issues in ob:
    • inability to recognize or appropriately respond to intrapartum fetal compromise
    • Inability to timely c-section (30 mins from decision to incision)
    • Inability to approp initiate resuscitation of depressed neonate
    • Inapprop use of oxytocin or misoprostol leading to uterine rupture, fetal intolerance of labor or death
    • Inapprop use of forceps/vacuum or preventable shoulder dystocia
  82. Identical twins
    • Monozygotic twins
    • are from one zygote that divides in first week of gestation
    • Are genetically identical, similar in appearance
    • ALWAYS SAME GENDER
  83. Fraternal twins
    • dizygotic twins
    • result from fertilization from 2 eggs
    • May be same or differing gender
  84. Risk factors with twins for mom
    • Risk to both mom and fetuses increases w # of fetuses
    • Preterm labor and delivery rate 50% higher
    • premature/prolonged rupture of membranes related to over distention of uterus
    • HTN tend to develop earlier and more severe
    • Gest. diabetes
    • antepartum hemorrhage
    • Abruptio placenta and placenta previa
    • anemia
    • PE and C-section all more common with twins
  85. Risk factors for twin babys
    • increased morbidity and mortality
    • preterm delivery
    • increased LBW
    • increase of intrauterine growth restriction and discordant growth
    • elevated hcg
  86. What are the risks for monoamniotic twins versus those in separate amniotic sacs
    Monoamniotic twins have a fetal mortality rate of 50-60% due to entangling of umbilical cords
  87. Risk factors for multiple gestation in general
    • premature prolonged rupture of membranes
    • HTN & preeclampsia
    • Gest diabetes
    • hemorrhage, abruptio placenta, placenta previa
    • anemia
    • PE for mom
    • C-section
    • increase in fetal morbidity and mortality due to sharing uterine space and placental circulation
    • increase of LBW and IUGR
  88. Sickle cell anemia
    • most common genetic disease of people of African descent
    • causes disruption of red blood cells
  89. Cystic fibrosis
    • most common in european ancestry
    • causes thick mucus in bronchial tree and pancreatic ducts
  90. Tay-sachs disease
    • people of jewish ancestry
    • degeneration of nervous system, results in death by age 2
  91. PKU
    • Phenylketonuria
    • lack of enzyme to metabolize milk
    • caused by genetic mutation
    • Leads to severe mental and physical retardation
    • can be prevented by use of diet, beginning at birth, that limits phenylalanine
  92. Huntington's disease
    uncontrolled muscle contractions btwn 30 and 50 yrs of age followed by mental deterioration
  93. Hemophilia
    • Lack of factor 8 
    • impairs clotting
    • may be controlled with factor 8 from donated blood
  94. Duchenne's muscular dystrophy
    • replacement of muscle with adipose tissue and scars
    • often fatal before age 20 due to involvement of cardiac muscle
  95. Pregnancy drug categories
    • A = safest
    • B = no risks shown in humans
    • C = not enough research
    • D= adverse reactions
    • X = NEVER take in preganacy
  96. Fetal circulation
    • High levels of oxygenated blood enter fetal circulatory system from placenta via umbilical cord
    • ductus venosus connects umbilical vein to inferior vena cava, allowing majority of oxygenated blood to enter right atrium
    • Foramen ovale is opening in right and left atria, blood high in O2 shunted to left atriam
    • Ductus arteriosus connects pulmonary artery with descending aorta; majority of O2'd blood shunted to aorta w smaller amounts going to lungs
    • Afterwards, ductus arteriosus constricts in response to higher blood oxygen levels and prostaglandins
  97. What are possible consequences of not having proper number of vessels in umbilical cord
    2 in t0 babies with single umbilical artery have health problems, including heart kidney or digestion problems and genetic conditions
  98. Risk of drinking alcohol in pregancy
    • Fetal alcohol syndrome
    • Spontaneous abortion, abruptio, low birth weight
  99. GTPAL
    • G = Graviad (# of pregnancies)
    • T = Term (37 wks)
    • P = Pre-term (20-36 wks)
    • A = Abortion ( therapeutic or miscarriage before 20 wks)
    • L = living children
  100. Changes to urinary system
    • Increased renal blood flow
    • Rate of formation increased
    • Reabsorption of sodium, chloride, water
    • Increased glomerular filtration
    • Increased urinary tract infections
    • Urinary frequency
    • Decreased blood urea nitrogen & plasma creatinine level, renal threshold for sugar
  101. S/S of vena cava syndrome
    What can you teach mom about preventing
    • Occurs when mom lays on back after 20 wks, compresses vena cava
    • Characterized by pallor, bradycardia, sweating, nausea, hypotension, dizziness
    • Teach mom to rest on side, preferably left side
  102. How is HIV dx'd and treated in pregnancy
    • Screened for in prenatal visit with permission
    • Tx with at least 3 antiretroviral drugs during pregnancy reduces incidence of transmission to fetus to less than 2%
  103. What are ramifications for fetus (HIV)
    • Risk of transmission is 20-25%
    • If untreated, preterm delivery,
    • preterm PROM (rupture of membranes)
    • IUGR (Intrauterine growth restriction)
  104. How should the delivery be managed (HIV)
    • Avoid instruments during birth
    • leave membrane intact
    • avoid scalp electrode
    • avoid episiotomy and assisted delivery
    • provide and reinforce education
    • provide emotional support
  105. What is expected weight gain based on womans BMI
    • Underweight: 20-40 lbs (BMI of <1835)
    • Normal weight: 25-35 lbs (BMI 18.5-24.9)
    • Moderately overweight: 15-25 lbs (BMI 25-29.9)
    • Very Overweight/obese: 11-20 lb (BMI >30)
    • Recommended 2-4 lbs first trimester, 1 lb per week thereafter
  106. What are usual prenatal tests done at first prenatal visit?
    • CBC, Hgb, Hct, platelets
    • blood type and RH

    • serology (RPR) for syphilis
    • rubella screening
    • Hep B
    • HIV is offered but not standard
    • PPD (Tuberculosis)

    urinalysis
  107. Why is it important to know this (prenatal tests) early in preg
    • To prevent any complications in pregnancy that could harm the baby or fetus
    • Rhogam, ABX for group B strep, HIV medication, Rubella vaccination after birth
    • Low platelets = no epidural, treat anemia
  108. changes in breasts
    • breast tissue increase in size and nodularity as milk glands and ducts grow
    • nipples more erect
    • areola darker
    • colostrum as early as 16 weeks
  109. endocrine changes
    • increase in insulin resistance
    • increase in estrogen, progesterone, Human Placental lactogen, hCG, relaxin, and oxytocin
  110. GI changes in pregnancy
    • N/V - thought to be due to hCG and Progesterone
    • Increased salivation (ptyalism)
    • bleeding gums due to increased vascularity
    • heart burn
    • constipation and hemorrhoids from pressure of uterus
  111. Integumentary changes during preganancy
    • striae gravidarum
    • diastasis
    • oily skin and acne
    • hair and nail growth
    • hot flashes
    • facial flushing
    • increased prespiration
  112. changes in musculoskeletal during pregancy
    • enlarging uterus causes shift in center of gravity
    • Lordosis - low back pain
    • Relaxation and increased mobility of joints = waddle gait
    • diastasis rectus and round ligament pain
  113. What can you teach is the cause of Pica and test that could screen for likely result
    • Compulsion to ingest non food substances 
    • interferes with good nutrition and can lead ot anemia
    • Blood test done for iron and zinc, as could be deficient
  114. Recommendations to help alleviate and/or prevent nausea and vomiting in pregnancy
    • eat small, frequent meals
    • avoid spicy and high fat foods
    • plenty of rest
    • drink plenty of fluids
  115. What causes it N/V
    • Nausea during pregnancy appears to be linked with increase of Hcg and progesterone, and maybe estrogen increase and glucose decrease
    • Both nausea and these hormones peak at same time 4-8 weeks preg
    • N/V usually lasts through first trimester, but can extend through other trimesters
  116. What is hyperemesis gravidarum and how is it treated
    • Intractable vomiting in preg
    • Caused by an interplay of hormones, psychology and metabolism
    • Treatment is rest, parenteral fluids, antiemetics, and vit B6
    • Signs: maternal weight loss of 5% or more, dehydration, ketonuria, acetonuria, and/or electrolyte imbalance
  117. Good sources of protein for prego women
    • meat
    • dairy
    • nuts
    • eggs
    • beans
    • fish
  118. What are the recommendations for vegans (Protein)
    • Beans
    • nuts 
    • dark leafy greens
    • hemp
    • non-dairy milks (soy & almond)
    • quinoa 
    • tofu
    • lentils
  119. Danger signs in pregnancy that need notification to the provider immediately
    • vaginal spotting or bleeding
    • leaking fluid from vagina
    • unusual abd pain, cramping, pelvic pressure, persistent back ache
    • persistent or excessive N/V
    • persistent HA or blurred vision
    • marked swelling of hands/feet/face
    • painful/burning urination
    • foul smelling vaginal discharge
    • chills/fever
    • decreased fatal movement in 3rd trimester
  120. What is function of folic acid in pregnancy, how much is needed
    • 400 mcg/day
    • prevents neural tube defects
  121. What is function of iron in pregnancy, how much is needed
    • 30 mg/day - essential for making extra blood that mom and fetus need
    • also helps move oxygen from lungs to rest of body
    • prevents anemia
  122. What is function of calcium and how much is needed
    • 1000 mg/day
    • helps baby build strong teeth and bones
    • helps with development of muscles, heart, and nerves
    • development of normal heart rhythm
  123. What is function of Vit D and how much is needed
    • 400 IU
    • necessary for metabolism and absorption of calcium and phosphorus
    • essential for bone health
    • deficiency is linked to preeclampsia
  124. Special risk factors for pregnant nurses?
    • DVT's
    • varicose veins
  125. How is NST done and what is definition of reactive NST
    • Hook up FHR monitors for at least 40 mins and look for accelerations of at least 15 beats for 15 sec twice or more in 20 mins
    • IN fetus <32 weeks; two accels at least 10 beats above baseline for 10 sec in 20 mins

    Reactive NST means normal
  126. What are indications for doing NST
    • Used for elaluating fetal well being for high risk pregnancies including:
    • hypertension
    • diabetes
    • multiple gestation
    • trauma/bleeding
    • womans report of decreased fetal movement
    • placental abnormalities
  127. Instructions to mom about doing fetal movement kick counts and why are they done
    • Eat something, lay on side and palpate for kicks
    • In one hour more than k kicks is reassuring, in tow hours more than 10 kicks is reassuring
    • should be done daily after 28 weeks to assess fetal well being and could identify potentially hypoxic fetuses
  128. How and why would amniocentese be done
    • can be done to check surfactant levels in preterm babies, genetic testing, assessment of hemolytic disease or intrauterine infection
    • Done by inserting long needle guided by ultrasound into pocket of amniotic fluid through stomach and withdrawing sample
    • Done btwn 14-20 weeks for genetic testing
  129. What are critical nursing assessments after amniocentesis is done
    • Explain procedure, full bladder may be required
    • Provide comfort measures and emotional support
    • Nurse should assess FHR and maternal well being,
    • instruct not lift anything heavy for 2 days
    • Report abd pain or cramping, leaking of fluid, bleeding, decreased fetal movement, fever of chills
    • administer RhoGAM as ordered for RH-neg to prevent antibody formation
  130. What are the elements of a BPP
    • Biophysical profile
    • an ultrasound assessment of fetal reflexes and activities that are CNS controlled and sensitive to fetal hypoxia
  131. What is involved with BPP
    • breathing movements
    • gross body movement
    • fetal tone
    • amniotic fluid volume
    • heart rate reactivity observed for 30 min in addition to NST in high risk preg
  132. Scoring for BPP
    • each component gets a score of 2 if present and 0 if absent, 
    • 8/10 is reassuring
    • 6/10 is equivocal and may need to deliver depending on gestation age
    • 4/10 delivery is recommended and is correlated with chronic asphyxia
    • 2/10 or less means immediate delivery
  133. Causes, s/s, for placenta previa
    Placenta implants low on interior of uterine wall, near or over os

    • will have bright red painless bleeding
    • can be emergency needing c-section
  134. Risks and tx for placenta previa
    • Risks include previous previa, prior c/s, multiparity, abortion, advanced maternal age, GDM or HTN, smoking, uterine anomalies
    • VAGINAL EXAM CONTRAINDICATED
    • TX: expectant management if mild with no s/s of shock, not in labor and less than 36 weeks with reassuring FHR
    • Hospitalized on bed rest, monitored for bleeding and fetal wellbeing
  135. Causes and s/s for abruption placentae
    • Premature separation of placenta; either partial or complete
    • S/S - sudden onset intense abd pain, dark red vaginal bleeding, strong almost continuous contractions, uterine tenderness, board like uterus, fetal distress and signs of hypovolemic shock
  136. Risks and tx for abruption placentae
    • PIH, h/o previous abruption, abd trauma, smoking, meth and cocaine, premature rupture of membranes, thrombophilia, uterine abnormalities
    • If deteriorating maternal or fetal status, immediate c-section
    • If maternal status is stable and fetus is premature, hospitalization, close monitoring, steroids
  137. What are the trimesters broken down into
    • 1st trimester: wk 1 - 1k 12
    • 2nd trimester: wk 13 - wk 27
    • 3rd trimester: wk 28 - birth
  138. Care and teaching for pt on mag sulf
    • Assess vitals before beginning and every 5-15 mins during loading dose, then 30-60 mins till stable
    • Assess DTR's every 2 hrs
    • Monitor strict intake/output as pt with oliguria or renal disease at risk for toxic
    • Monitor serum levels (therap level 5-7 mg/dL)
    • Keep calcium gluconate immediately available
  139. molar pregnancy
    • A noncancerous tumor that develops in the uterus as a result of a nonviable pregnancy.
    • Tests will include ultrasound and blood hCg
    • Tx includes a D&C, possibly hysterectomy, and continued hCg monitoring
  140. Risk factors for ectopic preg
    • Higher with h/o STD
    • tubal surgeries
    • previous ectopic preg
    • endometriosis
    • altered hormones 
    • contraceptive failure from intrauterine device
    • SMOKING!!
  141. S/S of ectopic preg
    diagnostic test
    S/S: abdominal tenderness, spotting or bleeding

    Diagnose: transvaginal ultrasound for misplaced gestational sac, falling progesterone levels and/or plateauing hCg levels
  142. Ectopic preg tx
    • Laparoscopy to remove affected tube
    • OR
    • methotrexate for hemodynamically stable pt with unruptured mass <4cm
  143. Hormones secreted from placenta, what do they do
    • Estrogen: stimulates enlargement of breast and uterus
    • Progesterone: facilitates implantation, decreases uterine contractility
    • Human placental lactogen: promotes fetal growth by regulating glucose available to fetus
    • Chorionic gonadotropin: stimulates corpus luteum to continue to secrete progesterone and estrogen till placenta can secrete
  144. Prevention and tx for varicose veins in pregnancy
    • hydrate
    • embolism stockings
    • keep moving, be active
    • watch your weight 
    • don't strain (prevent constipation)
  145. Schedule for visits, reg checks of...
    • Q4 weeks to 28 weeks
    • Q2 weeks 28-36
    • Q week till delivery

    weight, BP, Urine for protein and glucose (checking for preeclampsia, and DM)

    Fetal: fundal height, fetal heart tones, fetal movement counts (3rd trimester)
  146. Lab tests at certain weeks:
    • 16-18 wk: Maternal serum alpha (quadruple screed), includes Hcg and estidoiol
    • 24 wk: repeat Hct/Hgb
    • 28 wk: glucose screening
    • 28 wk: antibody titers for Rh neg mom, Rhogam is neg at 28 weeks
    • 36 wk:Group B strep
  147. Maternal effects on GBS (Group B strep)
    • Most women are typically asymptomatic carriers
    • Sx include abnormal vag discharge, UTI and chorioamnionitis
  148. Fetal effects on GBS (Group B strep)
    Transmission rate is low, but infection can result in invasive GBS with permanent neurological sequalae
  149. Testing and treatment of GBS
    • Screening involves vaginal and rectal swab cultures at 35-37 wk gestation
    • If positive at 35-37 week or status is unknown, treat with abx in labor to prevent neonatal transmission
    • Penicillin or ampicillin IV
  150. Psychosocial changes in preg and how nurses can support clients
    • Accepting pregnancy
    • Id motherhood role
    • re-order relationship with partner
    • prepare for labor
    • fear of loss of control of self-esteem in labor
    • Nurse can help by teaching and reassuring of "normal symptoms"
  151. What is effect of asthma on preg woman and fetus
    • Varying levels of airway obstruction, bronchial hyperresponsiveness and bronchial edema
    • Uncontrolled increased risk of preeclampsia, HTN, and hyperemesis gravidarum

    Risk to newborn includes hypoxia, preterm birth and LBW
  152. Risk factors for GDM
    • Maternal age >25
    • Precious big babies, infant with anomalies
    • Previous preg or fam hx with GDM
    • recurrent monilial vaginitis (yeast inf)
    • obesity
    • HTN
    • Glycosuria on 2 successive visits
    • high fasting glucose
  153. GDM Effects on preg
    • Early in preg can cause SAB or congenital anomalies
    • IUGR
    • delay fetal lung maturity
    • cardiomyopathy
    • can lower intelligence, motor impairment, tendency to develop childhood obesity & type II DM in life
  154. Treatment of GDM
    • asside from reg dm tx, 
    • betamethazone is given to help mature fetal lungs in PTL
Author
jskunz
ID
322769
Card Set
M/B Unit 1
Description
Mother baby unit 1
Updated