Term
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Definition
| The union of a single egg and sperm. (Gamete formation, ovulation, fertilization, implantation) |
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Term
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Definition
| Penetration of the ovum by the sperm (with accompanying union of genetic material) |
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Term
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Definition
| (nidation) trophoblast secretes enzymes that burrow into the endometrium and bury the blastocyst. (6-10 days after conception) |
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Term
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Definition
| finger-like projections that develop out of the trophoblast to effect exchange of nutrients and O2. |
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Term
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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. |
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Term
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Definition
| eventually surrounds embryo and forms a sac and covers the umbilical cord |
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Term
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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 |
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Term
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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. |
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Term
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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. |
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Term
| The placenta functions by |
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Definition
simple diffusion
active transport
pinocytosis |
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Term
Functioning is directly related to maternal circulation. With maternal circulation dependent on
maternal blood pressure
condition of her vessels
maternal position
uterine contractions |
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Definition
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Term
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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 |
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Term
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Definition
| day 15-week 8 after conception |
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Term
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Definition
| day 15-week 8 after conception |
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Term
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Definition
(day 15 – week 8):
Critical period of development
structures/systems
Stage most susceptible to
teratogens |
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Term
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Definition
(week 9 – end of pregnancy):
Refinement and maturation
of structures/systems.
Critical period continues for
neurologic development
Cephalocaudal development |
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Term
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Definition
| period of intra-uterine development from conception through birth (pregnancy) |
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Term
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Definition
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Term
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Definition
| pregnant for the first time |
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Term
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Definition
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Term
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Definition
| the number of pregnancies in which the fetus or fetuses have reached viability ( ~20 weeks) |
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Term
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Definition
| a woman who has not completed a pregnancy to viability |
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Term
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Definition
| a woman who has completed one pregnancy to an age of viability |
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Term
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Definition
| a woman who has completed more than one pregnancy to viability |
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Term
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Definition
| loss of pregnancy prior to the age of viability |
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Term
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Definition
| fetal loss greater than the age of viability |
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Term
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Definition
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Term
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Definition
| 20 weeks-prior to 37 weeks gestation |
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Term
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Definition
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Term
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Definition
Earliest biochemical marker for pregnancy
Basis of test
Detected 7-10 days after conception |
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Term
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Definition
Blood or urine
Use radioactively labeled marker
Tests for beta subunit of hCG |
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Term
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Definition
serum
Measures ability to inhibit binding of radio-labeled hCG to receptors |
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Term
| Enzyme-linked immunosorbent assay (ELISA) |
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Definition
Urine
Most popular
Uses anti-hCG with enzymes to bond with hCG in urine |
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Term
| Changes to reproductive system during pregnancy |
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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. |
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Term
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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 |
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Term
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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 |
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Term
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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. |
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Term
| Changes to cardiovascular system |
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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. |
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Term
| Changes to respiratory System |
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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. |
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Term
| Metabolic Regulation in pregnancy |
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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 |
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Term
| Renal system changes in pregnancy |
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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. |
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Term
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Definition
mask of pregnancy,
fades after pregnancy |
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Term
| Human Chorionic Gonadotropin (HCG): |
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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. |
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Term
| Human Placental Lactogen (hPL): |
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Definition
also called Human Chorionic
Somatomammotropin is an antagonist
of insulin creating increased circulating
free fatty acids and glucose for metabolic
needs. |
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Term
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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) |
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Term
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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) |
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Term
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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" |
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Term
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Definition
Lipid substances
arising from most tissues but
greater concentrations in the female
reproductive tract.
Involved in initiation
of labor. Mechanism unclear. |
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Term
| Presumptive signs of pregnancy |
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Definition
1. Breast Changes
2. Amenorrhea
3. Nausea, Vomiting
4. Urinary Frequency
5. Fatigue
6. Quickening |
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Term
| Probable signs of pregnancy |
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Definition
1. Goodell’s sign
2. Chadwick’s sign
3. Hegar’s sign
4. Positive pregnancy test
5. Braxton Hick’s contractions
6. Ballotment |
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Term
| Positive signs of pregnancy |
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Definition
1. Visualization of fetus
2. FHT’s
3. Fetal movement palpated |
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Term
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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 |
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Term
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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) |
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Term
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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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