-
Contraindicated vaccinations during pregnancy
- MMR
- OPV
- Flu with nasal spray
-
Allowed vaccinations during pregnancy
- Hep B (only if they’ve been exposed)
- H1N1
- Health Promotion
-
What is a teratogen?
Any substance or agent that can cause abnormalities in fetal development
-
____ ____ cross the placental barrier and can cause harm to fetus
Most drugs
-
Smoking can cause _____
Low birth weight and prematurity
-
Alcohol can cause ____
Growth retardation and FAS
-
Life begins____
At conception
-
Mitosis is
Normal process of cell division- body cells
-
Meiosis is
Cell division that only occurs in reproductive cells.
-
Cellular division of the sperm is called
Spermatogenesis
-
Cellular division of the ovum (egg) is
Oogenesis
-
Each sperm has ____ chromosomes
23
-
Sperm can have _______ sex chromosomes
X or Y
-
Ova have _____ chromosomes
23
-
Ova only have _____ sex chromosomes
X
-
____ sperm develop from one sperm cell
4
-
____ ova develop from 1 egg cell
1
-
Fertilization occurs when
Sorry successfully penetrates an ovum
-
Fertilization occurs in the ______ of the Fallopian tube, the area ______ to the ovary.
- 1) outer third
- 2) closest
-
The egg can survive ____ after OVULATION
24hr
-
Sperm can survive _____ after ejaculation
5 days.
-
Sex determination occurs _____
At fertilization.
-
A fertilized cell is called (Sperm and Ova join)
A zygote
-
The size of the zygote_____
Never changes.
-
After three days the fertilized cells go through a cleavage and are known as
A morula
-
The inner layer of the morula that will form the embryo is called
Blastocyst.
-
The outer layer of the morula that develops into the chorion is called
Trophoblast.
-
Zygotes implant into the ____
Endometrium
-
After implantation, the endometrium is called
Deidua
-
The deidua basalis is
The area immediately under the blastocyst. Forms the maternal side of the placenta
-
The chorion is the ___ of the fetal membrane
Outer layer
-
The amnion is the ____ of the fetal membrane
Inner layer
-
The chorion envelopes the
Amnion, embryo, and yolk sac
-
The Amnion
Surrounds and protects the embryo and grows until it sticks to the chorion.
-
The amnion contains ____ ml of fluid at 10 weeks.
30
-
The amnion contains ____ ml of fluid at term
1000
-
Functions of the amniotic fluid
- Equalizes pressure
- Protects and cushions
- Maintains even temp and fluid for the fetus to swallow
- Allows movement and normal growth
- Lubricates and prevents sac from sticking to fetus.
-
Yolk sac functions
- Functions only during embryonic development
- Initiates production of RBC until 6 weeks when the liver takes over.
-
What is the placenta
Organ that provides nutrients, oxygenation, and waste removal for the fetus
-
The placenta has
1 umbilical vein and 2 umbilical arteries.
-
The umbilical vein
Carries oxygenated blood to fetus
-
The umbilical arteries
Carry deoxygenated blood and waste from fetus.
-
The placenta produced 4 hormones:
- Estrogen
- Progesterone
- hCG
- hPL
-
Estrogen
Stimulates uterine growth, helps with lactation, causes some physical changes during pregnancy
-
Progesterone
Maintains uterine lining, reduced contraction, and hell’s prepare for lactation.
-
hCG
Causes continued production of estrogen and progesterone to sustain pregnancy
-
hPL
Helps to make more glucose available to fetus to accommodate growth
-
Relaxing
Softens connective tissue in pelvis
-
What does Wharton’s jelly do
Protects the umbilical cord vessels ( arteries and veins)
-
How long is the umbilical cord
22inches
-
Zygote is what stage
Fertilization -3weeks
-
Embryo is what stage
3weeks-8weeks.
-
Fetal is what stage
Week 9- delivery.
-
Fetal development occurs
Cephalo-caudal
-
What are the three shunts needed in fetal circulation.
- Ductus arteriosus
- Ductus venosus
- Foraminifera ovale.
-
Describe ductus arteriosus
- Diverts blood from pulmonary artery to aorta
- (Lungs -body)
-
Describe ductus venosus
- Diverts blood from the liver to the inferior vena cava
- (Body- heart)
-
Describe foremen ovale
Connects right atria to left atria
-
Describe monozygotic twins.
- Identical
- Come from one egg (mono)
- Same sex
- Share placenta and chorion but have separate amnions
-
Describe dizygotic twins
- Fraternal
- Two eggs fertilized by two sperm
- May not be the same sex
- 2 separate placentas, chorions and amnions
-
What is fundal height
When uterus is just below xiphoid process
-
Progesterone continues to be produced for up to _____ weeks to maintain pregnancy
12
-
A mucus plug is formed in the ___
Cervix
-
During dilation, ____ be expelled from the cervix
Mucus plug
-
During pregnancy the _____ of the vagina may change to protect from infections.
ph
-
Chadwicks sign appear because of
Increased vascular congestion
-
Describe colostrum
- High in protein, vitamins, and minerals
- Provides immunity to baby
- Helps baby cleanse GI tract
-
During pregnancy _____ increases
- Circulating blood volume
- Pulse rate
-
What is vena cava syndrome
Occurs due to weight of the uterus. Reduced blood return to heart and can lead to fetal hypoxia
-
Oxygen consumption _____ during pregnancy
Increases
-
Changes in the GI system
- N/v
- Constipation from decreases motility and pressure from uterus
- Gas and heart burn
- Increases appetite and thirst
-
Pregnant women need ____ glasses of fluids a day
8-10
-
Linea nigra
Brown lines on belly
-
-
-
Presumptive signs of pregnancy
- Amenorrhea
- N/v
- Changes in breast
- Urinary frequency
- Fatigue/sleepiness
- Abdominal enlargement
- Quickening
-
Probably signs of pregnancy
- Goodells sign- softening of cervix
- Hegars sign- softening of lower uterus
- Chadwicks- blue discoloration due to increased BL food
- Uterine enlargement
- Braxton Hicks contractions
- Increased pigmentation
- Ballottement- rebounding of the fetus
- Positive pregnancy test
-
Positive signs of pregnancy
- Heart beat of fetus
- Rate goes down in latter part of pregnancy
- Ultrasound
- Fetal movements
- FHT
-
Normal heart rate for fetus early pregnancy
150-170
-
Normal heart rate for fetus later pregnancy
110-160
-
Gravida is
Total number of pregnancies
-
Para is
Births that reach 20 weeks
-
Preterm is
Delivery after 20 weeks but before 38
-
Term is
Pregnancy between 38-42 weeks
-
Post term is
Delivery after 42 weeks
-
Abortion is
Including induced and spontaneous (miscarriage)
-
Gestation age is
Calculated from first day of last missed period
-
Glucose tolerance test at ____
6-7 months
-
Estimate date of delivery
First day of LPM - 3 months + 7 days
-
TPALM
Gravida-
- Term
- Preterm
- Abortions
- Living
- Multiples
-
Pregnant women should increase daily calorie intake by
300 calories a day
-
Four main nutrients needed during pregnancy
- Protein- metabolic needs
- Calcium- bones and lactation
- Iron- fetal requirements and RBC
- Folic Acid- to prevent neural tube defects and RBC production
-
Total weight gain recommended
- 25-35lbs
- Less if overweight
- More if underweight
-
Hyperemesis gravidarum
- Severe n/v during pregnancy that goes last first trimester
- Caused by increased hCG and stress
-
Threatened abortion
Closed cervix. Spotting no tissue passed. Membrane intact
-
Inevitable abortion
Bleeding/cramping. Some cervical dilation with possible rupture of membranes.
-
Incomplete abortion
Cervix dilated. Passage of some tissue. Bleeding heavy and cramping severe
-
Complete abortion
- All
- Products of conception are expelled. Cervix closes and bleeding stops.
-
Missed abortion
Fetus dies in uterine but is not expelled. Cervix closed. Not FHT.
-
Recurrent abortion’s
Series of 3 or more of any kind
-
Observe for ____ with abortion
Sepsis
-
_____ is given time Rh negative mothers
Rhogam
-
Incomplete cervix
- Painless dilation of cervix in 2nd trimester. Might cause habitual abortions
- Treated by cerclage( suturing cervix closed)
-
Ectopic pregnancy
Pregnancy where implantation occurs outside of uterus
-
Causes of ectopic pregnancies
- Scarring from IUD
- Infection
- Defects
- Adhesions
- Endometriosis
- Abnormal hormones.
-
S/s ectopic pregnancy
- *appear within 5 weeks of missed period *
- Lower quad pain
- Sudden severe lower pain
- Vagina bleeding
- Possible shock
-
Hydatidiform mole
- Molar pregnancy
- Malformation in development of placenta. Chorionic villa abnormally increase and develop cyst like sacs that look like grapes
*can lead to cancer.
-
S/s of hydatidiform mole
- No FHT
- Vaginal bleeding
- Fundal height greater that expected
- S/s of PIH
- Servers vomiting
- High hCG
- Snowstorms on US
-
Treatment for molar pregnancy
- Evacuate uterus
- Hysterectomy
- Avoid pregnancy for 1 year
- Give rhogam
- Test hCG
-
Placenta previa
Vaginal bleeding that occurs in late pregnancy. Placenta implants and develops in lower uterine segment and overlies the cervical os.
-
Classifications first placenta previa
- Complete
- Partial
- Low lying
-
Complete placenta previa
Placenta completely covers cervical os
-
Partial placenta previa
Partially covers cervical os
-
Low lying placenta previa
Placenta within 2-3cm of cervix.
-
S/s placenta previa
- Painless vaginal bleeding
- Fetal distress and hypoxia
- Abnormal baby presentation.
- Infection
-
Treatment for placenta previa
- Avoid pelvic exams
- C section if complete
- C section if partial
- If low lying- vaginal delivery but c section is preferred.
Steroids early on.
-
Abruptio placentae
Premature separation of placenta from uterine wall. Can be partial or compete. Causes fetal distress.
-
S/s of abruptio placentae
- Vaginal bleeding
- Severe pain
- Rigid board like abdomen
- FHT los or absent
- Sudden fetal inactivity
- Hemorrhage
-
Treatment for abruptio placentae
- C section
- Bloood snd clotting factor replacement
-
Gestational hypertension
- Aka toxemia or pregnancy induced hypertension.
- Cause unknown.
-
S/s PIH
- Appears after 20 weeks
- Hypertension BP greater than 140/90
- Or bp 30/15 higher than prepreg bp
- Edema
- Proteinuria
- Oliguria
- Blurred vision
- Ha
- Seizures
-
Four classifications for PIH
- Preeclampsia
- Mild
- Severe
- Exclampsia
-
Eclmapsia is Diagnosed when
Convulsive stage begins
-
Goal bs for pregnant women
70-105
-
Gestation diabetes
- Developes because of pregnancy in 2nd or 3rd trimesters.
- Diagnosed with GTT 24-28 weeks
- Goal BS 70-105
-
TORCH GROUP
- Toxoplasmosis (neuro damage low weight)
- Other.. hiv, hep b, tb, and group b step. (Tested around 30 weeks )
- Rubella (microcephaly, MR)
- Cytomegalovirus (mr, Blindness, deafness)
- Herpes virus ( neuro effects- requires c section. May cause death)
-
RH incompatibility
- Rh factor is either present or absent in the blood
- Mother and baby blood usually doesn’t mix but if it does and Rh is there, body will produce anti bodies.
- Antibodies are permanent.
- Can cross placenta and destroy fetal RBC
-
Treatment for RHA INCOM.
- Rhogam at 28 weeks and within 72 hrs of delivery
- Not beneficial if sensitization has already occurred.
-
FAS causes
S/s flat nasal bridge, thin upper lip, poorly formed grove above lip, microcephaly, short eye tissue Mc jittery nature.
-
Drug addiction
- Small weight
- Withdrawal symptoms
- Some defects
- Neuro defects
-
Preterm labor
- Begins after 20 weeks but before 37
- Causes vary
- S/s
- Contractions, PROM, cervical dilation and effacement
- Tx
- Depends.
- Attempts to stop labor of dilated less than 4cm
- Not stopped if health is at risk.
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