Term
|
Definition
| assessment of fetal activity by the mother |
|
|
Term
|
Definition
| major uses include; determine gestational age, confirm placenta placement,and biophysical profile |
|
|
Term
|
Definition
includes; qualitative amniotic fluid volume, fetal breathing and gross body movements, fetal tone and reactive fetal
heart rate |
|
|
Term
|
Definition
| includes: alpha-fetoprotein, L/S ratio,Coombs’ test |
|
|
Term
|
Definition
| performed to obtain amniotic fluid which contains fetal cells |
|
|
Term
|
Definition
| Screen for diagnosis of neural tube defect |
|
|
Term
| chorionic villis sampling |
|
Definition
| popular technique for genetic studies |
|
|
Term
|
Definition
| evaluation of placental function by fetal heart response to fetal movement |
|
|
Term
| CST- contraction stress test |
|
Definition
| fetal heart response to contractionelicited by nipple stimulation or oxytocin |
|
|
Term
|
Definition
| pregnancy specific hypertension characterized by hypertension and proteinuria |
|
|
Term
|
Definition
| onset of hypertension without proteinuria after 20 weeks of pregnancy |
|
|
Term
|
Definition
| >1+ protein on dipstick measurement |
|
|
Term
|
Definition
| systolic BP greater than 160/110 and >2+ protein |
|
|
Term
|
Definition
onset of seizure activity or coma
in a woman diagnosed preeclampsia |
|
|
Term
|
Definition
| type of severe preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets |
|
|
Term
|
Definition
| assessment of fetal lung maturity |
|
|
Term
|
Definition
| hypertension not pregnancy induced |
|
|
Term
| A non stress test NST was just completed on a woman who is 42 weeks gestation. The results were 1 FHR acceleration of 10 bpm lasting 15 seconds and 1 FHR acceleration lasting 10 seconds within a 40 minute period. The nurse would document the result as? |
|
Definition
|
|
Term
| Reactive NST is characterized by |
|
Definition
| 2 or more accelerations of the FHR of at least 15 bpm lasting 15 seconds in a 20 minutes period as a result of fetal movement. Good baseline variability and normal baseline rate are also required for the test to be considered reactive. |
|
|
Term
| When conducting a contraction stress test (CST) the nurse should: |
|
Definition
| Document a positive if late decelerations occur with more than 50% of teh contracitons |
|
|
Term
| A woman at 28 weeks gestation has been diagnosed with gestational diabetes the nurse caring for thsi patient should know that: |
|
Definition
| Dietary management involves distributing nutrients over three meals or two or three snacks |
|
|
Term
| A pregnant woman can reduce her risk of toxoplasmosis by: |
|
Definition
| Avoiding the handling of cat litter, soil or raw meat |
|
|
Term
| Research has found that bed rest as an intervention for preventing pre-term labor can result in: |
|
Definition
| Bone demineralization with calcium loss |
|
|
Term
| A woman at 10 weeks gestation calls the prenatal clinic to report that she is experiencing vaginal bleeding. What should the nurse's intitial response be? |
|
Definition
| Describe your bleeding to me (onset, duration, amount and any associated symptoms such as cramping) |
|
|
Term
| A woman with sever preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment will be evaluated as successful if: |
|
Definition
|
|
Term
| pregnant woman with cardiac disease is informed about the signs of cardiac decompensation. Shs should be told that the earliest sign of decompensation is most often: |
|
Definition
|
|
Term
| A nulliparous woman in labor has been diagnosed with a prolonged latent phase of the first stage of labor. Which of the following is true regarding this dysfunctional labor pattern? |
|
Definition
| Management often involves therapeutic rest. |
|
|
Term
| A woman at 36 weeks is admitted to the high risk pregnancy unit with gestational hypertension. Assessment findings indicate severe preeclampsia. The nurse should: |
|
Definition
| Expect a maintenance dose of magnesium sulfate between 1 and 2 grams per hour. |
|
|
Term
| A woman with gestation hypertension has just given birth and is now in the recovery room. Upon reading the physician's post partum orders the nurse would question which of the following medication orders? |
|
Definition
Methergine
This medication is an effective oxytocic used to prevent hemmorhage but can raise BP especially if given parenterally |
|
|
Term
| Singns of threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion? |
|
Definition
| Prepare the woman for a sonogram to determine the integrity of the gestational sac. |
|
|
Term
| A woman with marginal placenta previa gave birth vaginally 15 minutes ago.At the present time she is at greatest risk for? |
|
Definition
Hemorrhage
Because the lower uterine segment has limited ability to contract to reduce blood loss |
|
|
Term
| A woman at 14 weeks gestation is admitted to the hospital with a diagnosis of hyperemisis gravidarum. The primary goal of her treatment at this time would be to: |
|
Definition
| Reduce fluid, electrolyte and acid base imbalances that are present. |
|
|
Term
| A woman at 27 weeks gestation calls the nurse stating taht she thinks that her labor has begun. She describes contractions of increasing frequency and duration accompanied by discomfort in her lower back. The nurse should instruct this woman to: |
|
Definition
| Empty her bladder and drink 2-3 glasses of water or juice. |
|
|
Term
| A woman is diagnosed with gestational diabetes. When planning the prenatal care for this woman, the nurse identifies actions based on the knowledge that: |
|
Definition
| The danger of DKA is highest at the second and third trmesters. |
|
|
Term
| A hospitalized woman in preterm labor is being given magnesium sulfate IV. The expected outcome for this treatment will be met if: |
|
Definition
| Labor contractions are suppressed |
|
|
Term
| Inadequate (single visit) and/or poor quality postpartum care may |
|
Definition
| prevent the pick-up of complications such as: infection, DVT and postpartum hemorrhage. |
|
|
Term
| Leading causes of maternal mortality in the US: |
|
Definition
Hemorrhage
Pregnancy related hypertensive disorders
Infection |
|
|
Term
| Factors related to maternal death: |
|
Definition
Age (younger then 20 older then 35)
Lack of prenatal care
Low educational attainment
Unmarried status
Non-white race |
|
|
Term
|
Definition
Purpose is to prevent fetal morbidity
and mortality
FHT
Fetal activity
Fetal growth as reflected by fundal height |
|
|
Term
Physiology of fetal surveillance
Fetal development and health depends upon |
|
Definition
Maternal cardiac output
Uterine blood supply
Placental respiratory function
State of the umbilical cord |
|
|
Term
|
Definition
Fetal Movement, "kick counts"
Ultrasound
BPP
Amniocentesis, CVS
AFP
NST
CST |
|
|
Term
|
Definition
DX of pregnancy (gestational sac)
Viability of pregnancy (fetal/cardiac movement, growth
Uterine abnormalities, IUDs, Masses
Ectopics, Moles
Dating (BPD, femur length, crown-rump: correlates best before 24 weeks)
DX of Multiple gestations
DX of growth problems (symmetrical vs asymmetrical, serial ultrasounds)
Fetal anomalies
Amniotic fluid volume
Placenta locations and maturity (grading) |
|
|
Term
|
Definition
is a type of ultrasound exam looking at
-Fetal breathing movement (FBM)
-Fetal tone (FT)
-Fetal movement (FM)
-Amniotic Fluid volume (AFV)
-Non Stress test
A score of 8 out of 10 or above is desirable |
|
|
Term
|
Definition
Aspiration of amniotic fluid/fetal cells it contains.
Purpose
-At 14-15 weeks: Karyotyping, looking for metabolic disorders or chromosomal abnormalities
-Fetal maturity later in pregnancy: measure phospholipids L/S ratio: Lecithin to sphingomyelin/Shake test = AF + saline +alcohol = shake/if bubbles remain after 15 minutes than have mature lungs
Hemolytic DX: bilirubin levels in fluid.
Amniotic fluid problems such as meconium (thick vs. thin, old vs. new) |
|
|
Term
|
Definition
| indicates fetal lung maturity. |
|
|
Term
|
Definition
| indicates an increased risk of respiratory distress syndrome (RDS) at delivery. |
|
|
Term
|
Definition
| high risk of developing RDS. |
|
|
Term
| Not a good indicator of fetal maturity for diabetic patients |
|
Definition
|
|
Term
|
Definition
a protein secreted by the fetal liver
generally used to provide a screening for neural tube defects like spina bifida and anacephaly.
Low levels associated with Downs Syndrome.
Currently offered to all patients if they are seen early enough (between 15 – 20 weeks) |
|
|
Term
|
Definition
Indications:
Decreased fetal movements
Going beyond the due date
Diabetes
High blood pressure
Changes in fetal growth rate |
|
|
Term
|
Definition
2 or more accelerations of at least 15 bpm lasting 15 seconds over a 20 minute period (or 10x10 before 32 weeks)
Normal baseline rate
Moderate variability |
|
|
Term
|
Definition
done when indicated at 34 or more weeks gestation
IV Oxytocin or nipple stimulation is used to stimulate contractions. |
|
|
Term
|
Definition
| No late or severe variable FHR decelerations with 3 contraction of 40-60 seconds in a 10-minute period |
|
|
Term
|
Definition
| Late decelerations with 50% or more of contractions |
|
|
Term
|
Definition
| currently is the leading cause of pregnancy-related death during the first trimester in the United States, accounting for 9% of all pregnancy-related deaths. |
|
|
Term
|
Definition
occurs before 12 weeks
90 % occur before 8 weeks
Possible causes: endocrine imbalance, immunologic factors, infections, systemic disorders and genetic factors |
|
|
Term
|
Definition
occurs between 12 – 20 weeks
Usually maternal causes
Advanced maternal age and parity
Chronic infections
Premature dilation of cervix
Chronic disease
Inadequate nutrition
Recreational drug use |
|
|
Term
|
Definition
spotting of blood
Cervical os closed
Mild uterine cramping may be present |
|
|
Term
|
Definition
Moderate – heavy bleeding
Open cervical os
Mild to severe cramping |
|
|
Term
|
Definition
| Expulsion of fetus with retention of placenta requires D&C |
|
|
Term
|
Definition
All fetal tissue passed
Cervix is closed
Slight bleeding
Mild uterine cramping may be present |
|
|
Term
|
Definition
Fetus has died
Contents retained in uterus up to several weeks
No bleeding or cramping
Cervical os closed
requires US, D&C |
|
|
Term
|
Definition
Uncommon
Fever and abdominal tenderness
Slight to heavy bleeding
Malodorous
Surgical evacuation |
|
|
Term
|
Definition
|
|
Term
|
Definition
Painless dilatation of the cervix without contractions of the uterus
Obvious danger is abortion or preterm delivery
Risk factors: DES exposure, prior traumatic delivery, frequent or forceful dilatation and curettage of the cervix
Diagnosis occurs in pregnancy: If caught early enough then can do a cerclage if Cervix is less than 3 cm dilated and 50% effaced this is usually successful. Often on bed rest |
|
|
Term
|
Definition
Premature separation of placenta
Risk factors
Maternal hypertension
Cocaine use
Blunt external abdominal trauma
Multiple gestation
Signs and Symptoms
Vaginal bleeding
Abdominal pain
Uterine tenderness
Contractions
Mortality
Maternal – 1%
Perinatal – 15-30% |
|
|
Term
|
Definition
Placenta is implanted in lower uterine segment near or over the internal cervical os
Incidence – 0.5% of births
Greater risk
Previous previa
Multiple gestation
Closely spaced pregnancies
Maternal age >35
African or Asian ethnicity
Smoking
Cocaine use
Signs and symptoms:
Painless, bright red, vaginal bleeding
Diagnosis: Trans-abdominal ultrasound |
|
|
Term
| Velementous insertion of the cord |
|
Definition
| Insertion is away from placenta with vessels in-between, exsanguination of the fetus is a danger when ROM |
|
|
Term
|
Definition
| marginal insertion increased risk of fetal bleed |
|
|
Term
|
Definition
| separate lobes to placenta with risk of fetal bleed if vessels joining the two rupture and can leave on in mother with subsequent bleed or infection. Easy to have an unknown piece of placenta left in. |
|
|
Term
|
Definition
Risk factors:
Gestational hypertension
HELLP
Retained dead fetus
Amniotic fluid embolism
Sepsis
Hemorrhage
Signs and Symptoms
Spontaneous bleeding from gums, nose
Oozing
Petechiae
Bruising
Hematuria
GI bleeding
Tachycardia
diaphoresis
Treatment
Supportive measures
O2
Blood
delivery |
|
|
Term
| Gestational Hypertension: |
|
Definition
| BP elevation after mid-pregnancy |
|
|
Term
|
Definition
| Resolves within 12 weeks pp (retro diagnosis) PIH without proteinuria |
|
|
Term
|
Definition
| Syndrome of PIH after 20 weeks with proteinuria Mild Severe |
|
|
Term
|
Definition
Chronic (underlying)Hypertension
Chronic Hypertension with Superimposed Pre-eclampsia |
|
|
Term
3 key factors
in assessment of pre-eclampsia |
|
Definition
Elevation of Blood Pressure
Edema
Proteinuria |
|
|
Term
|
Definition
140/90 x 2 4-6 hrs apart
Proteinuria on dipstick
Exam may be normal with DTRs 2-3+
May see sudden wt. gain, slight generalized edema
Fetal assessment usually normal as placental perfusion is reduced but not excessively |
|
|
Term
|
Definition
BP 160/110 or higher on 2 occasions, 6hrs apart
Proteinuria/ 3-4+ on dipstick
DTRs 3-4+ with possible clonus
Headaches
Blurred vision/visual problems
RUQ pain/epigastric pain,
Oliguria <500ml/24 hours
Impaired liver function
Thrombocytopenia
Fetal assessment: late decelerations |
|
|
Term
|
Definition
| Convulsions (possibly coma, hypertensive crisis, or shock) |
|
|
Term
|
Definition
| Convulsions (possibly coma, hypertensive crisis, or shock) |
|
|
Term
| Management of Mild Pre-eclampsia |
|
Definition
Increased rest (left lateral)
Quit or limit work
Adequate diet/increased protein
Close monitoring with increased frequency of visits
Baseline lab work
Urine for protein
PIH panel |
|
|
Term
| Management of Severe Pre-Eclampsia |
|
Definition
Usually requires hospitalization
Frequent BP, FHT, DTR, edema, urine,
daily weights
Lab work as indicated
Assure protein intake
Enforce bed rest
Seizure precautions
Implement plan of fetal surveillance (NST’s and US)
Provide teaching and support for patient and her family
If Seizure: Protect patient from injury/oxygen, suction
Implement pharmacologic support as ordered |
|
|
Term
| Postpartum care of pre-eclampsia |
|
Definition
Continue to monitor closely as condition warrants
Magnesium sulfate: Usually continue 12-48 hours
Monitor fundal tone
Urine output should be observed, should see diuresis within 72 hours
Support and teaching
After delivery, the patient must be monitored as closely and frequently as during labor; 25% of cases of eclampsia occur postpartum, usually in the first 2 to 4 days. |
|
|
Term
|
Definition
Use: Prevention and control of convulsions, not an antihypertensive
Urinary output is affected: increases Na retention and is itself excreted by the kidneys. Must maintain a retention catheter with output of at least 30 ml/hr.
If <30 ml/hr, physician is notified and dosages altered.
Dosage:
Loading 4-6 gm IV over 15-30 minutes
Maintainance1-3 gm /hr IV |
|
|
Term
|
Definition
Hemolysis, Elevated Liver enzymes, Low Platelets
A life threatening extension of the pathology of severe pre-eclampsia.
Evidence of intravascular hemolysis
Liver enzymes must be elevated
Platelet count of <100.000/mm3 |
|
|
Term
|
Definition
| The union of a single egg and sperm. (Gamete formation, ovulation, fertilization, implantation) |
|
|
Term
|
Definition
| Penetration of the ovum by the sperm (with accompanying union of genetic material) |
|
|
Term
|
Definition
| (nidation) trophoblast secretes enzymes that burrow into the endometrium and bury the blastocyst. (6-10 days after conception) |
|
|
Term
|
Definition
| finger-like projections that develop out of the trophoblast to effect exchange of nutrients and O2. |
|
|
Term
|
Definition
| covers the fetal side of placenta and has all the big vessels in it bring fetal blood to the placenta for exchange of nutrients and O2. |
|
|
Term
|
Definition
| eventually surrounds embryo and forms a sac and covers the umbilical cord |
|
|
Term
|
Definition
* initially a filtrate of maternal blood
* serves as cushion
* protects the cord
* maintains body temp
* helps fetus grow symmetrically
* provides testing material for fetal studies |
|
|
Term
|
Definition
initially the stalk which attaches early embryonic cell mass to the chorionic villi,
has 2 arteries and 1 vein, with an average length of 22 inches at birth.
Wharton’s jelly surrounds vessels. |
|
|
Term
|
Definition
Organ of metabolic exchange (respiration, nutrition, excretion, storage) and hormone production
Semi-permeable barrier able to keep out many compounds, proteins, bacteria, etc that are of large molecular weight but not many of the deleterious enemies of the fetus fit this description. |
|
|
Term
| The placenta functions by |
|
Definition
simple diffusion
active transport
pinocytosis |
|
|
Term
Functioning is directly related to maternal circulation. With maternal circulation dependent on
maternal blood pressure
condition of her vessels
maternal position
uterine contractions |
|
Definition
|
|
Term
|
Definition
A means of metabolic exchange
Respiration
Nutrition
Excretion
Storage
Endocrine gland producing four hormones to maintain pregnancy
Human chorionic gonadotropin (hCG)
Human chorionic somatomammotropin (hCS) or hPL
Progesterone
Estrogen |
|
|
Term
|
Definition
| day 15-week 8 after conception |
|
|
Term
|
Definition
| day 15-week 8 after conception |
|
|
Term
|
Definition
(day 15 – week 8):
Critical period of development
structures/systems
Stage most susceptible to
teratogens |
|
|
Term
|
Definition
(week 9 – end of pregnancy):
Refinement and maturation
of structures/systems.
Critical period continues for
neurologic development
Cephalocaudal development |
|
|
Term
|
Definition
| period of intra-uterine development from conception through birth (pregnancy) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| pregnant for the first time |
|
|
Term
|
Definition
|
|
Term
|
Definition
| the number of pregnancies in which the fetus or fetuses have reached viability ( ~20 weeks) |
|
|
Term
|
Definition
| a woman who has not completed a pregnancy to viability |
|
|
Term
|
Definition
| a woman who has completed one pregnancy to an age of viability |
|
|
Term
|
Definition
| a woman who has completed more than one pregnancy to viability |
|
|
Term
|
Definition
| loss of pregnancy prior to the age of viability |
|
|
Term
|
Definition
| fetal loss greater than the age of viability |
|
|
Term
|
Definition
|
|
Term
|
Definition
| 20 weeks-prior to 37 weeks gestation |
|
|
Term
|
Definition
|
|
Term
|
Definition
Earliest biochemical marker for pregnancy
Basis of test
Detected 7-10 days after conception |
|
|
Term
|
Definition
Blood or urine
Use radioactively labeled marker
Tests for beta subunit of hCG |
|
|
Term
|
Definition
serum
Measures ability to inhibit binding of radio-labeled hCG to receptors |
|
|
Term
| Enzyme-linked immunosorbent assay (ELISA) |
|
Definition
Urine
Most popular
Uses anti-hCG with enzymes to bond with hCG in urine |
|
|
Term
| Changes to reproductive system during pregnancy |
|
Definition
Uterus
• Increases in both numbers and size of cells, increased vascularity, and development of decidua
• Process of enlargement is hormonal in first trimester and mechanical after that.
• Shape of the uterus changes as it rises out of abdomen
• There is a correlation between uterine size and weeks gestation
• Increased uterine blood flow and pelvic congestion produce Chadwick's sign; bluish color to the cervix
• Capacity of the uterus grows 500, even 1000 times
• The round ligaments that help to hold the uterus in place, enlarge and stretch, eventually the intestines are pushed to the side.
• Non-expulsive contractions called Braxton Hicks contractions begin to facilitate blood flow. |
|
|
Term
|
Definition
• Chadwick's sign.
• Glandular tissue becomes hyperactive and produces a thick tenacious mucous which plugs the cervix.
• Appearance of the cervical os changes with parity.
• In pregnancy there is increased friability |
|
|
Term
|
Definition
• Hormones thicken the mucosa, loosen the connective tissue and prepare the vaginal for birth
• Estrogen causes exfoliation of the vaginal mucosa, this rapid shedding of cells coupled with the increased secretion due to the high vascularity create an increase in vaginal discharged called leukorrhea
The pH changes, becoming more acidic |
|
|
Term
|
Definition
• Can be one of the first things a woman notices when she is pregnant. Fullness, tingling, nipples become very sensitive.
• Increased pigmentation of the nipples and areola
• Increased vascularity is noted by the visibility of blood vessels that create a network visible beneath the skin.
• Montgomery's tubercles, small sebaceous glands in the areolar tissue enlarge produce a natural lubricant
• Striae may appear.
• If a pregnancy ends after 16 weeks the milk will come in
• High levels of estrogen inhibit the milk producing hormone prolactin from being secreted however colostrum is present in the third trimester. |
|
|
Term
| Changes to cardiovascular system |
|
Definition
• Adaptation to meet increased metabolic needs created by pregnancy.
• Mild cardiac hypertrophy secondary to increased blood volume.
• Auscultatory changes: More audible split s1-s2 after 20 weeks and common to have systolic ejection murmurs but not over grade II
• Pulse increases to 10-15 BPM over her norm
• Arterial blood pressure decreases slightly in the first trimester, with a low point in the second trimester and returns to normal by the third trimester.
• Orthostatic hypotension is common as are varicosities and edema.
• Blood volume increases 30 -50% starting around ten weeks.
• Physiologic anemia.
• RBC production is accelerated.
• WBC levels increase then remain stable.
• Cardiac output is greatly increased.
• Function can significantly affected by maternal position and activity
• Coagulation tendencies are increased. |
|
|
Term
| Changes to respiratory System |
|
Definition
• Structural changes occur: rib cage relaxes, there is an increase in the diameter of thoracic cage
• Small degree of pregnancy induced hyperventilation due to progesterones effect on the CNS
• Increase vascularity leads to congestion of upper airways and nasal and sinus stuffiness, epitaxsis and even voice changes. |
|
|
Term
| Metabolic Regulation in pregnancy |
|
Definition
• BMR is increased related to the increased oxygen demands and increased cardiac work. Dissipation of excess heat from this increased BMR is why pregnant women feel so warm and sweat a lot.
• Thyroid function increases in response to higher BMR |
|
|
Term
| Renal system changes in pregnancy |
|
Definition
• Ureters, renal pelvis dilate, smooth muscles like the linings of bladder, uterus and urethra have relaxed tone
• Relaxed tone makes women more susceptible to stagnant urine and infection, especially since the threshold for glucose is lower in pregnancy and glycosuria may be present creating an even more favorable environment for bacteria.
Renal System
• Ureters, renal pelvis dilate, smooth muscles like the linings of bladder, uterus and urethra have relaxed tone
• Relaxed tone makes women more susceptible to stagnant urine and infection, especially since the threshold for glucose is lower in pregnancy and glycosuria may be present creating an even more favorable environment for bacteria.
Renal System
• Ureters, renal pelvis dilate, smooth muscles like the linings of bladder, uterus and urethra have relaxed tone
• Relaxed tone makes women more susceptible to stagnant urine and infection, especially since the threshold for glucose is lower in pregnancy and glycosuria may be present creating an even more favorable environment for bacteria.
• Decreased bladder tone may make the bladder hold far more urine then normal...if the mechanical pressures don't make her void every half-hour.
• GFR is increased due to blood volume and demands for waste excretion are increased with fetal waste present.
• To maintain the blood volume needed, the kidneys increase their ability to retain Na.
• Protein in urine in measurable amounts is abnormal and a sign of renal disease
• The best maternal position for renal function is the left lateral recumbent. |
|
|
Term
|
Definition
mask of pregnancy,
fades after pregnancy |
|
|
Term
| Human Chorionic Gonadotropin (HCG): |
|
Definition
Secreted by trophobast in
early pregnancy to stimulate corpus
lutem to continue estrogen and
progesterone production in order
to maintain the pregnancy until
the placenta can assume that function. |
|
|
Term
| Human Placental Lactogen (hPL): |
|
Definition
also called Human Chorionic
Somatomammotropin is an antagonist
of insulin creating increased circulating
free fatty acids and glucose for metabolic
needs. |
|
|
Term
|
Definition
Secreted first from
the corpus luteum by the seventh
week of pregnancy it is mostly a
placental hormone.
It stimulates uterine development
to provide an appropriate
environment for the fetus
It helps to develop the ductal system
of the breast. (tissue building and
increased vascularity) |
|
|
Term
|
Definition
Produced first by the
corpus luteum and then by the placenta
It plays the greatest role in maintenance
of the pregnancy.
It maintains the endometrium and inhibits uterine contractility. (smooth muscle relaxation; uterus, G-I ,vessels) |
|
|
Term
|
Definition
The primary source
is the corpus luteum but some
may come from the placenta or
decidua.
Acts to inhibit uterine contractions
Softens cervix and "remodel collegen" |
|
|
Term
|
Definition
Lipid substances
arising from most tissues but
greater concentrations in the female
reproductive tract.
Involved in initiation
of labor. Mechanism unclear. |
|
|
Term
| Presumptive signs of pregnancy |
|
Definition
1. Breast Changes
2. Amenorrhea
3. Nausea, Vomiting
4. Urinary Frequency
5. Fatigue
6. Quickening |
|
|
Term
| Probable signs of pregnancy |
|
Definition
1. Goodell’s sign
2. Chadwick’s sign
3. Hegar’s sign
4. Positive pregnancy test
5. Braxton Hick’s contractions
6. Ballotment |
|
|
Term
| Positive signs of pregnancy |
|
Definition
1. Visualization of fetus
2. FHT’s
3. Fetal movement palpated |
|
|
Term
|
Definition
History: Demographics
Gyn history
Family history
Medical history
OB history (previous pregnancies)
Present pregnancy
LMP vs. LNMP
EDC: Nagele’s Rule
Pregnancy tests
Planned pregnancy and is father supportive?
Problems or events of this pregnancy
Signs and symptoms of pregnancy
Patient preferences: Support persons, birth plans, planned medications, early DC |
|
|
Term
|
Definition
expected date of confinement or delivery
266 days from conception
280 days from first day of LMP assuming a 28 day cycle
9 calendar months
10 lunar months (4 week months) |
|
|
Term
|
Definition
Based on 28 day regular cycle
Add one year
Subtract 3 months and add 7 days to the
first day of the last menstrual cycle. |
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Term
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Definition
a complete physical, focusing on the reproductive system.
assessment of the nipples related to breastfeeding
assessment of the fundal height, or assessment of uterine size by bimanual exam.
FHTs
DTRs, edema and varicosities
Measurement of the adequacy of the bony pelvis |
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Term
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Definition
Blood work
type and Rh, antibody screen for Rh
or other blood related antibodies
serology RPR or VDRL
HBsAg
Rubella screen
CBC
Maternal serum AFP/prenatal risk screen between 14-18 weeks. Or earlier if “sequential screening” indicated or requested
HIV screen by inclusion
Cultures:
GC, Chlamydia, Herpes only with lesions or to check for cervical shedding
Urinalysis and culture is necessary
Pap smear
Others as history indicates: Sickle prep, PPD |
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Term
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Definition
Typically see clients
1x/month till 28 weeks
2x/month 28-36 weeks
1x/week 36-40 weeks
more frequently if go past 40 weeks, at least 2x/week.
client weighs self and checks her urine looking for glycosuria or proteinuria
Midwife or nurse does BP
Chart to compare to norms and observe pattern
Encourage and answer questions.
Anticipatory Guidance |
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Term
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Definition
28, 36 weeks Hct
28 weeks 1 hour post 50gm glucola
28 weeks Rhogam if Rh neg
Cultures as history deems necessary |
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Term
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Definition
Fundal Height Measurements
Fetal Heart tones: Doptone, Fetascope
Fetal Movement: Quickening, Monitoring
Fetal Position: Leopold maneuvers
Discuss progress of pregnancy
share patterns of growth: weight, fundal height
how new developments such as quickening compare to norms
refer to fetus as a person |
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Term
| 1st trimester anticipatory guidance |
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Definition
Hazards
Radiation
Drugs
Hyperthermia
Infections – viral/bacterial
Danger signals
Severe vomiting [ hyperemesis gravidarum
Chills, fever, burning on urination, diarrhea [ infection
Abdominal cramping; vaginal bleeding [ miscarriage, ectopic pregnancy
Discomforts/relief measures
Nausea and Vomiting
Urinary frequency
Breast tenderness
Increased vaginal discharge (leukorrhea)
Nasal stuffiness and epitaxis
Ptyalism
Mood swings/ambivalence |
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Term
| 2nd trimester anticipatory guidance |
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Definition
Discomforts and Relief Measures:
Pigmentation deepens; acne, oily skin
Spider nevi
Pruritus
Palpitations
Supine hypotension and bradycardia
Faintness
Food cravings
Heartburn
Constipation
Flatulence with bloating/belching
Varicose veins
Headaches
Carpal tunnel syndrome
Periodic numbness, tingling of fingers
Round ligament pain
Join pain, backache, pelvic pressure
Teaching related to Danger Signs For:
Preterm labor
Hypertensive conditions |
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Term
| Third trimester anticipatory guidance |
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Definition
L&D material
Discomforts / Relief measures
Heartburn
Dependent edema
Varicosities, hemorrhoids
Constipation
Backache
Leg cramps
Faintness
Shortness of breath
Insomnia
Mood swings, ambivalence, increased anxiety
Urinary frequency and urgency
Braxton Hicks uterine contractions
Danger Signals: Decreased Fetal Movements |
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Term
Preterm Labor
Incidence: 10%
Morbidity and Mortality
83% morbidity
Causes: 50% unknown
Risk factors and Causes
Signs and symptoms: |
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Definition
Uterine contractions q 10min or more frequent with or without other signs
Menstrual-like cramps felt in lower abdomen constant or intermittent
Low dull backache felt below the waistline either constant or intermittent
Pelvic pressure that feels like the baby is pushing down either constant or intermittent
Abdominal cramping with or without diarrhea
Increase or change in vaginal discharge |
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Term
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Definition
Expected pattern is 2-5lbs in the first trimester and about a pound (450g) a week in the second and third trimesters
Poor weight gain is defined as less then 2.2lbs or 1kg per month in the second and third trimesters. |
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Term
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Definition
Baby 7 -8.5 pounds
Amniotic fluid 2
Placenta 2-2.5
Uterus 2
Breasts 1-4
Increased Blood Volume 4-5
Increased Fluid 3-5
Maternal stores 4-6 |
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Term
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Definition
| variable but we use 300 calories as the average. For increased BMR, energy needs |
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Term
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Definition
| 60 gms is needed for just about everything...fetal and placental growth, maternal blood volume and constituents, maternal tissues, to maintain colloidal osmotic pressure and store reserves. |
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Term
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Definition
| 30 mg above norm of 15 mg needed. Needed to make RBCs and for fetal stores. |
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Term
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Definition
| recommended 0.4- 0.8 mg multiple pregnancy. RX prenatal vitamins usually have .08. Needed in DNA synthesis and maternal erythropoiesis. |
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Term
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Definition
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Term
| Every pregnant women should be on a multivitamin with |
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Definition
| minerals (iron, mag, zinc, cal/pho) and folic acid. |
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Term
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Definition
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Term
The Psychological Trimesters of Pregnancy
FIRST TRIMESTER: |
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Definition
Focus is on self, begins to do "cost Analysis” the benefits vs. the worries...may be unsure and scared...moody. Watches and analyzes every physical change. (Body Image)
Ambivalence is a common trait of early pregnancy even in the most planned pregnancy. Not accepting pregnancy does not mean not accepting the child. |
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Term
The Psychological Trimesters of Pregnancy
SECOND TRIMESTER: |
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Definition
Mother feels movement...fetus says "I am!"
Mother is interested in producing a healthy baby and looks to ways to do so...proper eating etc.
This is the time when she feels best. Develops a narcissism love of self...baby and she are one.
May become involved in traditional feminine activities; cooking, crafts.
Tends to seek out other pregnant women or recent mothers.
May increase or renew contact with her own mother.
Begins to question what the baby will be like, sex etc
Increasing feelings of protectiveness towards infant and increasing sense of vulnerability about herself. |
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Term
The Psychological Trimesters of Pregnancy
THIRD TRIMESTER: |
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Definition
Increasing intensity in feelings of vulnerability...sees world as hostile, doesn't want to be alone.
Sees herself as alone …no one really cares or understands...may seek additional support
Sees the baby as simultaneously one with her but separate from her
Focus is on labor and delivery
process...fears, unsure.
Wants to hear birth stories.
Childbirth classes to increase
knowledge base.
Increasing discomfort helps
to separate fetus from mother
"I want out of this" tired of pregnancy. |
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Term
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Definition
Acceptance of pregnancy
Reordering of relationships
Acceptance of fetus as a separate individual
Acceptance of the mother/father role
Resolution of fears about childbirth
Attachment |
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