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Autonomy
the right to self determination
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Respect for others
all persons equally valued
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Beneficence
Obligation to do good
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Nonmaleficence
Do no harm
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Justice
equal and fair treatment of others
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Fidelity/Faithfulness
obligation to keep promises
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Veracity
obligation to tell the truth
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Utility
the greatest good for the individual
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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
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hydramnios
- too much amniotic fluid
- 1500-2000 cc
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oligohydramnios
- Less than 500cc amniotic fluid at term
- often due to fetal kidney issues or decrease in placental function
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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
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Amniotic membrane
- Actually 2 membranes:
- Chorionic membrane - outermost fetal membrane
- Amniotic membrane - closest to fetus
- so adherent, seems like one
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amnion
- also called amniotic membrane
- Produces amniotic fluid and phospholipid that forms prostaglandins
- May be part of trigger for labor
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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
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Whartons jelly
- surrounds vessels in umbilical cord
- prevents cord from collapsing
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Presumptive s/s of pregnancy
- amenorrhea
- breast changes
- N/V
- uterine enlargement
- frequency urination
- quickening
- fatigue
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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
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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
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ONLY positive s/s of prego
- ultrasound visualization - p 4 weeks
- Fetal heart sounds - 10 - 12 weeks
- Fetal movement felt by examiner
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amenorrhea
lack of menstration
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quickening
fetal movement
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chadwicks sign
- color change in vagina and cervix
- more bluish
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Goodell's sign
softening of cervix
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Hegar's sign
softening of lower uterine segment
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EDD
- Estimated date of delivery
- Naegele's rule:
- count back 3 months from first day of last menstrual period, then add 7 days
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Para
number of pregnancies that reached viability, regardless whether infants were born alive or not
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viability
pregnancy that reaches 20 weeks
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gravida
woman who is or has been pregnant
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primigravida
woman who is pregnant for first time
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primipara
woman who has given birth to 1 child past age of viability
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multigravida
woman who has been pregnant previously
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Nullipara
woman who has never been and is not pregnant
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chloasma
- also called melasma
- tan or dark skin discoloration, usually on cheeks, upper lip, chin and forehead
- "Butterfly mask"
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diastasis rectus
separation of stomach muscles
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couvade syndrome
syndrome in which father also experiences N/V, weight gain, increased frequency to pee
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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
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doppler umbilical flow studies
assessing for placental sufficiency
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amniocentesis
- taken btwn 14 and 20 weeks
- tests for chromosomal defects
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fetoscopy
inspection through tiny tube inserted by amniocentesis for biopsy, some surgery
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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
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absolutely NO sex if:
- bleeding
- preterm labor
- rupture
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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
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miscarriage
if baby is lost before 20 weeks
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decidua
thick layer of modified mucus membrane that lines the uterus during pregnancy and is she with afterbirth
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tocalytics
meds given to try and stop labor
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bethamethazone
if baby comes before 34 weeks, given to baby to help lungs
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clonus
when you flex mom's ankles, the feet don't just smoothly relax back - will beat back
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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
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mag sulfate
- is a smooth muscle relaxant
- given so mom doesn't seize (in HTN)
- Also given in preterm labor to help stop labor
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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
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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.
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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.
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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...
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What are TORCH infections and how are they detected
- Toxoplasmosis
- Other (Heb B)
- Rubella
- Cytomegalovirus
- Herpes
Detected from TORCH blood screen
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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
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Toxoplasmosis: Effects on mom
often asymptomatic but can cause fatigue, muscle pain, pneumonitis, myocarditis, lymphadenopathy
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Toxoplasmosis: effects on baby
- severity varies with gestational age.
- Can lead to:
- spontaneous abortion
- low birth weight
- hepatosplenomegaly
- anemia
- neurological disease
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"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
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Other - Hep B: effects on mom
- almost half are asymptomatic
- Other have low fever, nausea, preterm labor/delivery
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Other - Hep B: effects on baby
- have 90% chance becoming chronically infected, HBV carrier,
- 25% risk developing liver disease
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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
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Rubella: effects on mom
- Rash
- Lymph node enlargement
- slight fever
- HA and malasie
- Just don't feel well
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Rubella: effects on baby
- Anomalies include:
- Deafness
- eye defects
- CNA anomalies
- severe cardiac malformations
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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
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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
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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.
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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
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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
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embryo
term used for developing human from time of implantation through 8 weeks of gestation
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Fertilization
the fusion of gametes to initiate the development of a new individual organism.
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fetus
term used for developing human from 9 weeks gestation to birth
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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
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implantation
embedding of the blastocyst into the endometrium of the uterus
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Lightening
- term used to describe the descent of the fetus into the true pelvis
- occurs approx 2 weeks before term in first-time pregnancies
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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.
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Progesterone
- smooth muscle relaxant
- preparing breasts for lactation
- inhibiting uterine contractility
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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
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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
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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
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Identical twins
- Monozygotic twins
- are from one zygote that divides in first week of gestation
- Are genetically identical, similar in appearance
- ALWAYS SAME GENDER
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Fraternal twins
- dizygotic twins
- result from fertilization from 2 eggs
- May be same or differing gender
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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
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Risk factors for twin babys
- increased morbidity and mortality
- preterm delivery
- increased LBW
- increase of intrauterine growth restriction and discordant growth
- elevated hcg
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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
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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
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Sickle cell anemia
- most common genetic disease of people of African descent
- causes disruption of red blood cells
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Cystic fibrosis
- most common in european ancestry
- causes thick mucus in bronchial tree and pancreatic ducts
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Tay-sachs disease
- people of jewish ancestry
- degeneration of nervous system, results in death by age 2
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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
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Huntington's disease
uncontrolled muscle contractions btwn 30 and 50 yrs of age followed by mental deterioration
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Hemophilia
- Lack of factor 8
- impairs clotting
- may be controlled with factor 8 from donated blood
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Duchenne's muscular dystrophy
- replacement of muscle with adipose tissue and scars
- often fatal before age 20 due to involvement of cardiac muscle
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Pregnancy drug categories
- A = safest
- B = no risks shown in humans
- C = not enough research
- D= adverse reactions
- X = NEVER take in preganacy
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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
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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
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Risk of drinking alcohol in pregancy
- Fetal alcohol syndrome
- Spontaneous abortion, abruptio, low birth weight
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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
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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
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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
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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%
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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)
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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
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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
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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
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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
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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
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endocrine changes
- increase in insulin resistance
- increase in estrogen, progesterone, Human Placental lactogen, hCG, relaxin, and oxytocin
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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
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Integumentary changes during preganancy
- striae gravidarum
- diastasis
- oily skin and acne
- hair and nail growth
- hot flashes
- facial flushing
- increased prespiration
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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
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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
-
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
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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
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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
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Good sources of protein for prego women
- meat
- dairy
- nuts
- eggs
- beans
- fish
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What are the recommendations for vegans (Protein)
- Beans
- nuts
- dark leafy greens
- hemp
- non-dairy milks (soy & almond)
- quinoa
- tofu
- lentils
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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
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What is function of folic acid in pregnancy, how much is needed
- 400 mcg/day
- prevents neural tube defects
-
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
-
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
-
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
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Special risk factors for pregnant nurses?
-
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
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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
-
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
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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
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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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
What are the trimesters broken down into
- 1st trimester: wk 1 - 1k 12
- 2nd trimester: wk 13 - wk 27
- 3rd trimester: wk 28 - birth
-
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
-
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
-
Risk factors for ectopic preg
- Higher with h/o STD
- tubal surgeries
- previous ectopic preg
- endometriosis
- altered hormones
- contraceptive failure from intrauterine device
- SMOKING!!
-
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
-
Ectopic preg tx
- Laparoscopy to remove affected tube
- OR
- methotrexate for hemodynamically stable pt with unruptured mass <4cm
-
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
-
Prevention and tx for varicose veins in pregnancy
- hydrate
- embolism stockings
- keep moving, be active
- watch your weight
- don't strain (prevent constipation)
-
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)
-
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
-
Maternal effects on GBS (Group B strep)
- Most women are typically asymptomatic carriers
- Sx include abnormal vag discharge, UTI and chorioamnionitis
-
Fetal effects on GBS (Group B strep)
Transmission rate is low, but infection can result in invasive GBS with permanent neurological sequalae
-
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
-
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"
-
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
-
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
-
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
-
Treatment of GDM
- asside from reg dm tx,
- betamethazone is given to help mature fetal lungs in PTL
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