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Obstetrics Chapter 42
Mosby's Paramedic textbook 3ED-R
83
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Professional
04/19/2012

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Term
Where does fertilization occur
Definition
in the fallopian tube
Term
After fertilization what is the ovum(oocyte) called
Definition
zygote
Term
After a few days of rapid cell division, the ball of cells is called
Definition
morula
Term
The morula has cell differentiation between the inner cells and the outer cells, what are these layers called
Definition
Blastocyst (inner cells), and trophoblast (outer cells)
Term
Whats the function of the trophoblast cells
Definition
they attach to the endometrium lining of the uterus, and they go on to make various life support systems for the embryo(placenta, amniotic sac, umbilical cord)
Term
What does the Blastocyst cells do
Definition
These cells form the embryo itself
Term
Which structures provide nutrients for the developing embryo
Definition
placenta, umbilical cord, and amniotic sac.
Term
How long do the trophoblast cells continue to develop the placenta
Definition
about 14 days
Term
What are the five functions of the placenta
Definition
Transfer of gases, transport of nutrients, excretion of wastes, hormone production, and formation of a barrier.
Term
At what month does the placenta secrete its own hormones, and which hormones are they
Definition
By the third month, and it produces estrogen, and progesterone, these hormones are produced to maintain the uterine lining, prevent the occurrence of menses, and stimulate changes in the women's breast, vagina, cervix, and pelvis
Term
The placenta barrier blocks some harmful substances, what medications easily cross the placental barrier
Definition
steroids, narcotics, anesthetics, and some antibiotics.
Term
What is the umbilical cord consist of
Definition
Two arteries, and one vein
Term
Explain the blow flow in the two arteries in the umbilical cord
Definition
The arteries carry deoxygenated blood from the fetus to the placenta
Term
Explain the blow flow in the vein of the umbilical
Definition
The vein carries oxygenated blood to the fetus from the placenta
Term
What structures are unique to fetus circulation
Definition
ductus arteriosus, ductus venosus, and the foramen ovale.
Term
What is the ductus arteriosus, and its function
Definition
Its an opening between the pulmonary artery, and the aorta, the blood coming from the right ventricle goes through the ductus arteriosus into the aortic arch after the carotid arteries, to prevent deoxygenated blood going to the developing brain
Term
What is the ductus venosus, and its function.
Definition
Its a continuation of the umbilical cord, and empties directly into the vena cava. It serves as a shunt to allow most of the blood returning from the placenta to bypass the liver.
Term
What is the foramen ovale, and its function
Definition
Its an opening on the right atria for blood to bypass the right ventricle, and go directly into the left atria,for systemic circulation.
Term
What is the amniotic fluid consist of
Definition
fetal urine, secretions from the respiratory tract, skin, and amniotic membranes.
Term
On average how much amniotic fluid is produced by 5 weeks, and how much at birth
Definition
175-225 mL at 5 weeks, and about 1 L at birth
Term
What is an ovarian follicle
Definition
it is an oocytes surrounded by granulosa cells.
Term
What is an oocyte
Definition
It is immature ova (egg)
Term
What is the purpose of the fallopian tubes
Definition
To carry the ovum to the uterus
Term
What is a developing ovum called
Definition
embryo
Term
How long is the developing baby called a embryo
Definition
for the first eight weeks
Term
When is the embryo called a fetus
Definition
after eight weeks and up until birth
Term
Where does fertilization occur
Definition
in the fallopian tube
Term
Explain gestation
Definition
The period in which the fetus develops and grows in the uterus. Usually lasts 40 weeks
Term
When does conception usually occur
Definition
14 days after the first day of the last menstrual period
Term
Define birth
Definition
The infant's loss of the placental connection with the mother, also the baby losses metabolic support.
Term
How much negative pressure is needed by the newborn to open its alveoli
Definition
More than 25mmHg, most newborns create as much as 50mmHg.
Term
What happen physiologically to the newborn's heart after birth
Definition
Pressure on the right side of the the heart decreases due to reduced resistance in the pulmonary arteries, and vascular resistance is increase systemically, causing the pressure on the left side to increase, closing the shunts needed during gestation
Term
Explain what gravida is
Definition
It is the number of all the woman's current and past pregnancies
Term
Explain what para is
Definition
It is the number of pregnancies that have resulted in live birth
Term
What lunar month is the infant's sex determined
Definition
The fourth
Term
What lunar month if born the infant cries, and breaths, but often results in death
Definition
the seventh
Term
What happens to the pH level in the vagina during pregnancy
Definition
The pH decreases to about 3.5 becoming acidic, to keep the vagina free from pathogens.
Term
What kind of ECG and cardiovascular changes could you see with a pregnant pt
Definition
On the ECG you may see flat or negative T waves in lead 3, Cardiac output increases by 30%(by the 34th week), the rate may increase by 15-20 beats/min(by third trimester)
Term
What changes would you see with a pregnant pt's respiratory system
Definition
The tidal and minute ventilation increase by 30-40% in late pregnancy,
Term
The increase in estrogen and progesterone causes the fibrinogen levels to increase by how much
Definition
50%
Term
The uterus is above the symphysis pubis at how many weeks
Definition
12-16 weeks
Term
Where is the uterus palpable at 24 weeks
Definition
Its at the level of the umbilicus
Term
When can fetal heart sounds be heard
Definition
at 16-40 weeks
Term
What is the normal range for fetal heart rate
Definition
between 120-160 bpm
Term
What is the greatest risk of fetal death
Definition
From fetal distress, and intrauterine demise caused by trauma to the mother or death
Term
What are some causes of cardiac arrest with pregnant pts
Definition
(Time of delivery)amniotic fluid embolism, drug toxicity, eclampsia (physiological assoc. w/ pregnancy)Aortic dissection, congestive caridomyopathy, PE
Term
Whats important to remember with pregnant pts when thinking about O2 saturation
Definition
Requirements are 10-20% greater than a nonpregnant pt
Term
Should you use vasopressors if the pt is pregnant
Definition
It not recommended, because it will decrease uterine blow flow and fetal O2 delivery
Term
What causes preeclampsia
Definition
The cause is unknown, and it mainly affects previously healthy normotensive women in their first pregnancy.
Term
When does preeclampsia occur
Definition
It usually occurs after 24 weeks gestation, often near term, and will not reverse until after delivery.
Term
What are the signs and symptoms of preeclampsia
Definition
Hypoperfusion to the tissue or organs involved. (cerebrum)headache, dizziness, confusion, seizures, coma (GI system)nausea, vomiting (placenta)abruptio placentae, fetal distress
Term
What is the criteria for preeclampsia
Definition
presence of the classic triad Hypertension, proteinuria, excessive weight gain with edema
Term
How do you manage seizures from eclampsia
Definition
place pt in left lateral recumbent, handle pt gently, minimize sensory stimulation, High flow O2, IV, be ready for another seizure and to administer mag sulfate 10%
Term
How is gestional diabetes mellitus caused
Definition
Its caused by pregnancy, and occurs in about 4% of all pregnancies
Term
What happens with gestioinal diabetes mellitus
Definition
The mother's body is unable to produce or use all the insulin it needs during the pregnancy, excessive amounts of glucose is transmitted to the fetus and is stored as fat
Term
What is the treatment for pt with GMD
Definition
regular glucose monitoring, exercise, diet modification, and sometimes insulin injections
Term
Define abortion
Definition
It is the termination of pregnancy from any cause before 20 weeks
Term
Define preterm birth
Definition
Any termination of pregnancy after 20 weeks gestation
Term
How many classes are there of abortion
Definition
8 types, complete, criminal, incomplete, induced, missed, spontaneous, therapeutic, and threatened
Term
Define what a miscarriage is
Definition
it is a spontaneous abortion
Term
What is abruoptio placentae
Definition
It is a partial or full detachment of a normally implanted placenta at more than 20 weeks
Term
What is placenta previa
Definition
IT is placental implantation in the lower uterine segment partially or completely covering the cervical opening
Term
Explain uterine rupture
Definition
It is a spontaneous or traumatic rupture of the uterine wall.
Term
What is Braxton-Hicks contractions
Definition
The irregular tightening of the pregnant uterus, usually begins in the first trimester, and usually painless. As pregnancy continues the contractions increase in frequency
Term
When does labor begin
Definition
It begins when the infant descends into the birth canal
Term
What are the stages of labor
Definition
Stage 1(Dilation), Stage 2(Expulsion), Stage 3(Placenta delivery)
Term
What happens in stage 1(Dilation)
Definition
Regular contractions, complete cervical dilation., average time 12. hrs primipara, 7hrs multipara
Term
What happens in stage 2(Expulsion)
Definition
Full dilation of cervix to delivery of the newborn, average time 80min in primipara, 30min multipara
Term
What happens in stage 3(placenta delivery)
Definition
Immediately after delivery of the infant, 5-20min
Term
What does Apgar stand for
Definition
Appearance(color), pulse(HR), grimace(reflex irritability),activity(muscle tone), and respiratory effort
Term
Whats an Apgar score of 10
Definition
The best possible condition
Term
Whats an Apgar score of 8
Definition
The infant is slightly depressed
Term
Whats an Apgar score of 4-6
Definition
The infant is moderately depressed
Term
Define postpartum hemorrhage
Definition
It is characterized by more than 500mL of blood loss after the delivery
Term
What is cephalopelvic disproportion
Definition
Its a condition in which the newborn's head is too large or the mother's birth canal is too small. This requires a c-section
Term
Explain a breech presentation
Definition
The largest part of the fetus(the head) is delivered last.
Term
What are the different categories of breech presentations
Definition
Front or frank, Complete, and incomplete
Term
What is a frank breech
Definition
When the infant's buttocks are presenting, with the infant's legs extended in front
Term
What is a complete breech
Definition
The infant's buttocks are presenting, with the infant's knee and hips flexed
Term
What is incomplete breech
Definition
The infant has one or both hips incompletely flexed, resulting in one or both legs/foot presenting
Term
What is shoulder dystocia
Definition
The fetal shoulders are wedged against the maternal symphysis pubis
Term
Define a premature birth
Definition
When an infant is born before 37 weeks gestation
Term
Define what uterine inversion is
Definition
Can occur suddenly after a contraction, its when the top of the uterus presents through the cervix
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