Module #1 Exam Maternal/NewBorn

Describe Appropriate nursing responses to non-reassuring FHR patterns.

1. Identify the cause of the nonreassuring pattern to plan appropriate interventions: 2. Stop oxytocin or other uterine stimulants. A tocolytic such as terbutaline may be ordered. 3. Reposition the woman, avoiding the supine position, for patterns associated with cord compression. Repositioning often improves other nonreassuring patterns as well. 4. Increase the rate of infusion of a nonadditive intravenous fluid to expand the mother's blood volume and improve placental perfusion. 5. Administer oxygen by facemask at 8-10 L/min to increase maternal blood oxygen saturation, making more oxygen available to the fetus. 6. Consider starting continuous EFM with internal devices if no contraindication exists. 7. Notify the physician or nurse-midwife as soon as possible, or ask another nurse to notify. Report and document the following 8. If the nonreassuring pattern is severe, other staff members should be alerted to the possibility of immediate delivery.

Identify signs and symptoms of overstimulation

Oxygenation Changes • Blood pressure, pulse, and respiratory instability • Cyanosis, pallor, or mottling • Flaring nares • Decreased oxygen saturation levels • Sneezing, coughing Behavior Changes • Stiff, extended arms and legs • Fisting of the hands or splaying (spreading wide apart) of the fingers • Arching • Alert, worried expression • Turning away from eye contact (gaze aversion) • Regurgitation, gagging, hiccupping • Yawning • Fatigue signs

Describe parental responses to pregnancy loss and identify nursing interventions to assist parents through the grieving process.

Parents experiencing perinatal death often feel alone in their grief because many people do not consider perinatal loss to be on the same level as the loss of an older child or adult. Interventions: Allowing expression of feelings: Stay with the parents as they express their feelings. Allow them to cry or respond as they wish. Acknowledging the infant: Recognize the infant as a person, allow it to be named, seen, & touched by the family. And be put to rest with dignity.

Describe differences between normal and abnormal findings during the newborn physical assessment.

Temperature Normal: Axillary: 36.5°C -37.5°C (97.7°F-99.5°F). Otherwise abnormal Pulses Heart rate 120-160 beats/min (100 sleeping, 180 crying). pulses present and equal bilaterally Respiration Rate 30-60 (average 40-49) breaths per min. Blood Pressure Average systolic, 65-95 mm Hg. Average diastolic, 30-60 mm Hg. Weight 5 lb, 8 oz to 8 lb, 13 oz Length Go to book pg 443/444

Develop a basic understanding of Genetics & genetic traits

Deoxyribonucleic Acid DNA is the basic building block of genes and chromosomes. It has three units: (1) a sugar (deoxyribose), (2) a phosphate group, and (3) one of four nitrogen bases (adenine, thymine, guanine, and cytosine). Gene A gene is a segment of DNA that directs the production of a specific product needed for body structure or function. Chromosomes Genes are organized into 46 paired chromosomes in the nuclei of most somatic cells(non-sex body cells). Twenty-two chromosome pairs are autosomes (non-sex chromosomes), and the 23rd pair is the sex chromosomes (XX in females, XY in males). Added or missing chromosomes or structurally abnormal chromosomes are usually harmful. Gametes Mature gametes (reproductive cells) are called haploid because they have half the chromosomes (23) of other body cells. One chromosome from each pair is distributed randomly in the gametes, allowing variation of genetic traits among people. Alleles Because humans have matched pairs of chromosomes (except the sex chromosomes in the male), they have two alleles for each gene—one on each member of the chromosome pair. The paired alleles may be identical (homozygous) or different (heterozygous). Dominance Dominance describes how one's genetic composition is translated into the phenotype, or observable characteristics. In the case of a dominant gene, one copy is enough to cause the trait to be expressed.

Describe pharmacological interventions for postpartum hemorrhage.

Early administration of oxytocin is recommended for all births as a prophylaxis against postpartum hemorrhage. Methylergonovine: Used for the prevention and treatment of postpartum or post abortion hemorrhage caused by uterine atony or subinvolution. Carboprost Tromethamine: Used for the treatment of postpartum hemorrhage caused by uterine atony. Also used for abortion. Use with caution in asthma patients.

Compare true labor with false labor.

False Labor Contractions: Inconsistent in frequency, duration, and intensity. A change in activity, such as walking, does not alter contractions, or activity may decrease them. Discomfort: Felt in the abdomen and groin. May be more annoying than truly painful. Cervix: No significant change in effacement or dilation of the cervix after an observation period of 1-2 h. True Labor Contractions: A consistent pattern of increasing frequency, duration, and intensity usually develops. Walking tends to increase frequency and strength of contractions. Discomfort: Begins in lower back and gradually sweeps around to the lower abdomen like a girdle. Back pain may persist in some women. Early labor often feels like menstrual cramps. Cervix: Effacement and/or dilation of cervix occurs. Progressive effacement and dilation of cervix are most important characteristics.

Identify how medications may affect a pregnant woman and the neonate.

Fetal effects of drugs given to the mother may be direct or indirect. Direct effects result from passage of the drug or its metabolites across the placenta to the fetus. For example, the FHR decreasing after the administration of pain medications. Indirect effects are secondary to drug effects on the mother. For example, a drug that causes hypotension in the mother, may result in hypoxia & acidosis in the fetus. Cardiac: Maternal Physiologic Alterations: Cardiac output increases, which indirectly affects hepatic and renal blood flow. Decreased plasma binding increases the amount of free circulating medications. HARDER FOR DRUGS TO BE ABSORBED INTO THE BLOOD STREAM DUE TO LOW ALBUMIN LEVELS. Respiratory: A pregnant woman's full uterus reduces her respiratory capacity, making her more vulnerable to reduced arterial oxygenation. GI: Progesterone slows peristalsis, reduces the tone of the sphincter at the junction of the stomach and esophagus, and decreases gastrointestinal absorption of any oral medications. This makes women at risk for aspiration & regurgitation. Nervous system changes: During pregnancy and labor, circulating levels of endorphins and enkephalins, morphinelike natural analgesics, are high. These substances modify pain perception and reduce requirements for analgesia and anesthesia medications.

Identify those clients who need referral, teaching, or emotional support

Genetic counselors provide services to help people understand specific genetic disorders and the risk of occurrence in their family. Clients with children who have birth defects. Helping families find appropriate support groups to help them cope with the daily stresses associated with a child who has a birth defect

Discuss parental responses when an infant is born with congenital anomalies and identify nursing interventions to assist the parents.

Grief describes the emotional response to loss. Mourning is the process of going through the phases of grief until the loss can be accepted and resolved. Birth of an infant with an anomaly evokes a grief response, and the family must mourn the loss of the perfect infant they imagined during the pregnancy. Interventions Both parents should be present when they are told about the infant's condition by the obstetrician or midwife. The nurse can use therapeutic communication techniques to help them express their feelings. They should receive as much information as possible about the condition and its effects.

Identify components of a postpartum assessment.

Initial Assessments • Vital signs • Skin color • Location and firmness of the fundus • Amount and color of lochia • Perineum (edema, episiotomy, lacerations, hematoma) • Presence, degree, and location of pain • Intravenous (IV) infusion (type of fluid; rate of administration; type and amount of added medications; patency of the IV line, redness, pain, or edema of the site) • Urinary output (time and amount of last void or catheterization, presence of a catheter, color and character of urine) • Status of abdominal incision and dressing, if present • Sensation level and ability to move if regional anesthesia was administered Chart Review • Gravida, para • Time and type of delivery (use of vacuum extractor, forceps) • Presence and degree of lacerations or episiotomy • Anesthesia or medications administered • Significant medical and surgical history, such as diabetes, hypertension, or heart disease • Medications given during labor and delivery or routinely taken and indications for their use • Food and drug allergies • Chosen method of infant feeding • Condition of the baby

Explain nursing interventions for successful bottle feeding

Instruct the parents to feed the infant every 3 to 4 hours. The infant takes only ½ to 1 oz per feeding during the first day of life but increases to 2 to 3 oz per feeding within a week. An infant who is satisfied often goes to sleep. Explaining feeding techniques such as burping the infant. Show the parents how to place the infant over the shoulder or in a sitting position with the head supported while they pat and rub the infant's back.

Explain the physiologic changes that occur during the postpartum period.

Involution (referring to the changes the reproductive organs, particularly the uterus, undergo after childbirth to return to their nonpregnant size and condition.) can be evaluated by measuring the descent of the fundus. The location of the uterine fundus helps determine whether involution is progressing normally. -The fundus descends by approximately 1 cm or one fingerbreadth per day -14 days after childbirth, the fundus should no longer be palpable. -Afterpains, or intermittent uterine contractions, cause discomfort for many women (multiparas, breastfeeding).

Explain differences between immature and mature findings when using the new Ballard scoring tool for gestational age assessment.

Look at the Picture

Describe the pharmacologic management of preeclampsia.

Magnesium sulfate (Anticonvulsant) is the drug most commonly used in the management of preeclampsia. Magnesium helps to prevent and control seizures. Magnesium acts as a CNS depressant by blocking neuromuscular transmission and decreasing the amount of acetylcholine liberated. If a woman's systolic is > 160 or diastolic > 110 then antihypertensive drugs like Hydralazine, nifedipine, and labetalol are used.

Identify pharmacologic management of pre-term labor.

Magnesium sulfate, Terbutaline, Nifedipine (Calcium Channel Blocker), and Indomethacin (Prostaglandin inhibitor) are used in tocolytic therapy in order to delay premature labor.

Describe safety measures for an infant under phototherapy

Maintain a neutral thermal environment, provide optimal nutrition, protecting the eyes, Position the lights the proper distance away from the infant. Lights that are too close risk burning the skin. Make sure to remove all clothing except diaper.

Describe interpretation of EFM data

Measures fetal heart rate and uterine contractions with: Fetal Doppler FHR and fetal movement can be recorded Tocodynamometer frequency and duration of contractions

Identify admission procedures for the laboring woman.

Notifying the physician or midwife • Gravidity, parity, abortions (spontaneous and elective), and term and preterm births • EDD; fundal height • Contraction pattern • Fetal presentation and position • Cervical dilation and effacement; fetal presentation and position; station of the presenting part • FHR and pattern • Maternal vital signs • Any identified abnormalities or concerns about the maternal or fetal condition • Pain, anxiety, or other reactions to labor Consent forms The woman signs consent for care during labor, anesthesia, vaginal birth, cesarean birth, and blood transfusion. Consent for newborn care is often completed as well. Laboratory tests Simple tests may be done on the unit, such as: • Hematocrit • Blood glucose levels • Midstream urine specimen for dipstick evaluation of protein, glucose, and ketone levels. Urinalysis and culture and sensitivity may be ordered for possible urinary tract infection. Other common routine tests done for every admitted perinatal patient include: • Complete blood count • Blood type and Rh factor • Rapid plasma reagin (RPR) or other test for syphilis • Hepatitis B surface antigen • HIV testing, if the woman consents Intravenous access If used, intravenous access is usually started with at least an 18-gauge catheter. A saline lock may be used, or the woman may receive continuous infusion of fluids.

Understand why and when an amniocentesis is performed

Amniocentesis is the aspiration of amniotic fluid from the amniotic sac for examination. Amniocentesis may be performed during the second or third trimester of pregnancy, depending on the purpose. Second-Trimester Amniocentesis: The primary purpose of midtrimester amniocentesis is to examine fetal cells present in amniotic fluid to identify chromosomal or biochemical abnormalities. Third-Trimester Amniocentesis: During the third trimester, amniocentesis may be used to determine fetal lung maturity or to evaluate fetal hemolytic disease that is often caused by Rh incompatibility. Reduction amniocentesis is a variation in which excess amniotic fluid is removed and discarded when hydramnios occurs.

Describe the focused assessments after birth.

A focused assessment for a vaginal delivery generally includes the vital signs, fundus, lochia, perineum, bladder elimination, breasts, and lower extremities. The assessment for post-cesarean mothers is more extensive.

Describe and be able to utilize APGAR scoring.

A= appearance (color all pink, pink and blue, blue [pale]) P= pulse (>100, < 100, absent) G= grimace (cough, grimace, no response) A= activity (flexed, flaccid, limp) R= respirations (strong cry, weak cry, absent)

Describe the purpose and use of routine prophylactic medications for the normal newborn.

Administering Vitamin K Because infants cannot synthesize vitamin K in the intestines without bacterial flora, they are deficient in clotting factors. Providing Eye Treatment Newborns also receive Erythromycin (0.5%) ophthalmic ointment to help prevent ophthalmia neonatorum in case the mother is infected with gonorrhea.

Identify newborn assessments for operative vaginal birth.

After birth, the mother and infant are observed for trauma. The mother may have vaginal wall lacerations or hematoma. Observe for skin breaks that allow entry of microorganisms. The FHR should be assessed, and any rate less than 100 beats/min should be reported.

Identify assessment findings that require immediate attention in the woman receiving regional pain management.

As with epidural opioids, nausea, vomiting, and pruritus may occur. Delayed respiratory depression may occur, depending on the drug used.

Identify infection prevention in newborns

Careful and frequent handwashing is the most important aspect of infection prevention. Handling and trauma to the skin should be minimized as much as possible to prevent skin breakdown and infection. Providing antibiotics: The nurse starts the IV fluids and ensures that medications are administered on time.

Identity the body system changes that occur during pregnancy.

Cervix: Estrogen causes hyperemia (congestion with blood) of the cervix, resulting in the characteristic bluish-purple color that extends to include the vagina and labia. Mucous plugs block the transfer of microorganisms. Vagina & Vulva: Increased vascularity of the vagina causes the vaginal walls, as well as the cervix, to appear a bluish purple in color. Loosening of the abundant connective tissue allows the vagina to distend during childbirth. Vaginal mucosa thickens, & vaginal rugae(folds) become very prominent. Ovaries: After conception, the major function of the ovaries is to secrete progesterone from the corpus luteum for the first 6 to 7 weeks of pregnancy. Ovulation ceases during pregnancy because the circulating levels of estrogen and progesterone are high, inhibiting the release of follicle-stimulating hormone. Breasts: The breasts become highly vascular, and a delicate network of veins is often visible. If the increase in breast size is extensive, lineal tears in the connective tissue (striae gravidarum or "stretch marks") may develop. The nipples increase in size and become darker and more erect, and the areolae become larger and more pigmented. Cardiovascular/Respiratory: Increase blood and oxygen consumptions. GI: Esophagus sphincter tone decreases which increases reflux. Increases in kidney size with increases GFR is normal. Bladder increases size in response to progesterone. Skin: hyperpigmentation, proliferation of skin blood vessels. Hair grows more rapidly. Musculoskeletal System: Calcium Storage is increased. Absorption of calcium is increased. Postural changes such as lordosis can occur. The abdominal wall also becomes stretched.

Explain teaching for the care of the newborn at home: cord care, circumcision care, SIDs. Discharge

Cord Care The cord becomes brownish black within 2 to 3 days and falls off within approximately 10 to 14 days. Fold the diaper below the cord so that it is not wet by urine. Cleaning the cord with water when necessary and keeping it clean and dry is the best method of cord care. Circumcision Care Observe the circumcision site at each diaper change. Call the physician if there are more than a few drops of blood with diaper changes during the first day or any bleeding after the first day. Continue to apply petroleum jelly to the penis with each diaper change for the first 4-7 days or as directed by your physician. If a PlastiBell was used, do not use petroleum jelly. Fasten the diaper loosely to prevent rubbing or pressure on the incision site. SIDS Always place your baby on the back for sleep. Discharge Care after discharge from the birth facility is very important. The AAP recommends that follow-up by a healthcare professional be provided within 48 hours of discharge to all newborns who go home from a birth facility less than 48 hours after birth. Care can be provided in the home, clinic, or office

Discuss ways to decrease respiratory distress in the preterm neonate.

Corticosteroids are often administered to speed fetal lung maturation if birth before 34 weeks seems inevitable. Betamethasone or dexamethasone can be used for this purpose.

Describe major mood disorders in terms of predisposing factors, cause, signs and therapeutic management.

Peripartum Depression: The woman experiencing PPD shows a depressed mood with loss of interest in her usual activities and a loss of her usual emotional response toward her family. The cause of peripartum depression is unknown. Depression responds best to a combination of psychotherapy, social support, and medication. Selective serotonin reuptake inhibitors and tricyclic antidepressants are the most commonly prescribed medications for moderate to severe peripartum depression. Postpartum Psychosis: Manifestations include agitation, irritability, rapidly shifting moods, disorientation, and disorganized behavior. Some mothers also have delusions about the baby and experience hallucinations. Bipolar II Disorder: Women with bipolar disorder suffer from periods of irritability, hyperactivity, euphoria, and grandiosity. They exhibit little need for sleep and are seldom aware they have a problem. The poor judgment and confusion they experience make self-care and infant care impossible and can be life-threatening for the mother and infant. Postpartum Anxiety Disorders: Panic disorder manifests as episodes of tachycardia, palpations, shortness of breath, chest pain, and fear of dying or of "going crazy."

Know the functions of the auxiliary structures

Placenta Its major functions are (1) metabolic, (2) transfer of substances between mother and fetus, and (3) endocrine. Fetal membranes The two fetal membranes are the amnion (inner membrane) and the chorion (outer membrane). The two membranes are so close as to be one, although they can be separated. Amniotic Fluid Amniotic fluid protects the growing fetus and promotes normal prenatal development by cushioning against impact & providing a stable temperature. Umbilical Cord The umbilical cord has two arteries that carry blood high in carbon dioxide and other waste products away from the fetus to the placenta, where these substances are transferred to the mother's circulation for elimination. The umbilical vein carries freshly oxygenated and nutrient-rich blood from the placenta back to the fetus.

Understand conception and the 3 periods of prenatal development

Pre-embryonic (Zygote) The pre-embryonic period is the first 2 weeks after conception. The zygote begins division and after it has reached 100+ cells, the zygote implants into the uterus. Embryonic The embryonic period of development extends from the beginning of the third week through the eighth week after conception. Basic structures of all major body organs are completed during the embryonic period. Fetal Beginning 9 weeks after conception and ending with birth, the rapidly dividing cells become a fetus. Dramatic growth and refinement in the structure and function of all organ systems occur during the fetal period. Teratogens may damage already formed structures but are less likely to cause major structural alterations.

Describe predisposing factors, causes, signs, and therapeutic management of thromboembolic disorders.

Predisposing factors/Causes Inactivity, bed rest, obesity, C-section, sepsis, smoking, diabetes mellitus, varicose veins, prolonged labor, dehydration, older than 35, family history of thrombosis, use of foreceps. Signs Signs and symptoms include swelling of the involved extremity as well as redness, tenderness, and warmth. Therapeutic Management Anticoagulant therapy such as Lovenox & heparin are used to prevent extension of thrombus.

Describe interventions to promote thermoregulation.

Preparing the environment before birth: Before the birth, prepare a thermal-neutral environment using a radiant warmer for use during initial assessments. Providing immediate care: Immediately after birth, place the infant on the mother's chest to provide warmth from skin-to-skin contact or under the radiant warmer Dry the wet infant quickly with warm towels to prevent heat loss by evaporation. Dry the hair well because the head has a large surface area, and damp hair increases heat loss. Remove towels or blankets as soon as they become wet, and replace them with dry, warmed linens. Cover the infant's head with a cap when the infant is not under a radiant warmer. Do not use a hat on an infant under the warmer because it prevents the transfer of heat to the head.

Understand the need for RhoGAM after delivery.

RhoGAM is an injectable medication used to prevent a condition called Rhesus (Rh) incompatibility (Antibodies from an Rh negative mother may enter the blood stream of her unborn Rh positive infant, damaging the red blood cells). It's commonly given to Rh-negative mothers who are expecting a Rh-positive baby. RhoGAM is given AFTER DELIVERY because it stops the antibody production so that future pregnancies will not be affected. During Delivery, there's is a chance that fetal blood may come in contact with the mother's blood. Once that happens, the body makes antibodies that will attack the fetus in later pregnancies. RhoGAM is given after delivery to prevent this.

Understand about teratogens and their effect on prenatal development.

Teratogens are agents in the fetal environment that either cause a birth defect or increase the likelihood that a birth defect will occur. Teratogens typically cause more than one defect, which distinguishes teratogenic defects from multifactorial disorders. However, children affected by single-gene and chromosome defects are also likely to have multiple defects, often making diagnosis difficult. Terratogenic agents include: Infections that travel across the placenta, Drugs/substances used by the mother, pollutants, chemicals, or other substances. Ionizing radiadion, hyperthermia, diabetes mellitus

Identify neonatal complications for the diabetic client.

The major complications of maternal diabetes for the newborn are hypoglycemia, hypocalcemia, hyperbilirubinemia, macrosomia, and respiratory distress syndrome. Hypoglycemia: At birth, when the maternal glucose supply is withdrawn, the level of neonatal insulin exceeds the available glucose, and hypoglycemia develops rapidly. Hypocalcemia: defined as a calcium concentration of less than 7 mg/dL, usually occurs within 72 hours of birth. Hyperbilirubinemia: The fetus who experiences recurrent hypoxia caused by maternal vascular impairment compensates by producing additional erythrocytes to carry oxygen supplied by the mother. After birth, the excess erythrocytes are broken down, releasing large amounts of bilirubin into the neonate's circulation.

Calculate a client's EDD using Nagele's Rule

The method involves subtracting 3 months from the first day of the last normal menstrual period, adding 7 days, and correcting the year, if appropriate. For example: LNMP October 30, 2012 Subtract 3 months = July 30, 2012 Add 7 days and correct the year = August 6, 2013

Explain nursing interventions for successful breastfeeding.

The mother may need assistance in positioning herself and the infant and a demonstration of how to hold the breast. Stay with the mother during the first few feedings to help her with problems that may arise. After the first feedings, check back frequently to answer questions. Use pillows or folded blankets to elevate the infant to the level of the nipple and prevent pulling and tension on the nipple.

Explain criteria for VBAC.

• No more than two previous low transverse uterine incisions • No other uterine scars (e.g., removal of fibroid tumors) or a previous uterine rupture • A pelvis that is clinically adequate for the estimated fetal size • No history of vertical cut. • Immediate availability of a physician during active labor if an emergency cesarean is needed • Availability of anesthesia and personnel to perform an emergency cesarean.

Discuss the risk factors of gestational diabetes mellitus.

• Overweight (body mass index [BMI] 25 to 25.9 kg/m2), obese (BMI 30 to 39.9 kg/m2), or morbidly obese (BMI ≥40 kg/m2) • Maternal age older than 25 years • Previous birth outcome often associated with GDM (neonatal macrosomia, maternal hypertension, infant with unexplained congenital anomalies, previous fetal death) • GDM in previous pregnancy • History of abnormal glucose tolerance • History of diabetes in a close (first-degree) relative • Member of a high-risk ethnic group (Hispanic, African, Native American, South or East Asian, or Pacific Islands ancestry)

Determine why alpha-fetoprotein screening is done

• The procedure is simple and requires only a sample of maternal blood. • It is the least invasive and most economical procedure to screen for an open body wall defect such as a neural tube defect or for chromosome abnormalities. • Prenatal diagnosis allows parents time to examine their options or to prepare for the birth of an infant who will need special care. • This screening tool must be viewed as the first step in a series of diagnostic procedures that are indicated if abnormal concentrations are found. Parents must decide whether to proceed each time another diagnostic test is offered.

Explain what Mothers need to know about feeding their newborns: breast and bottle.

The nutrients in breast milk are proportioned appropriately for the neonate and vary to meet the newborn's changing needs. Breast milk provides protection against infection and is easily digested. Maternal immunoglobulins, leukocytes, antioxidants, enzymes, and hormones important for growth are present in breast milk but not in formula. The AAP recommends that infants receive only breast milk for approximately the first 6 months. Breastfeeding should continue until the infant is at least 12 months old with the addition of complementary foods

Describe education for the woman with gestational hypertension.

The woman should be taught a regimen that includes rest; frequent monitoring of blood pressure, weight, and urine; and keeping a record of fetal movements.

Describe bonding and care of the premature infant

To promote family bonding with the infant, parents are involved as much as possible in the care of their infant.

know the terms related to pregnancy

Trimester: a period of three months. EDD: Estimated Date of Delivery, which is calculated by the LNMP (Last Normal Menstrual Period). Normal Pregnancy is 40Wks/280 days. Braxton Hicks Contractions: Sporadic uterine contractions, also known as false labor, & practice contractions. Striae Gravidarum: or "stretch marks" appear as slightly depressed pink to purple streaks on the abdomen, breasts, and buttocks. Colostrum Present beginning at 12-16 weeks of pregnancy and can readily be expressed from the breasts by the third trimester. Turns into breast milk 2-4 days after baby is born. Pyrosis upward displacement of the stomach allow reflux of acidic stomach contents into the esophagus and produces heartburn. Ptyalism excessive salivation that is unpleasant and embarrassing. Chloasma Also known as the melasma, or the mask of pregnancy. Consists of brownish patches over the forehead, cheeks, and nose. Linea nigra Dark vertical line that make a midline division on the abdomen. Quickening Subtle fetal movements that gradually increase in intensity. Begin between 16 & 20 weeks. Goodell's Sign Collagen fibers in the connective tissue of the cervix decrease, causing the cervix to soften. Chadwick's Sign (Sign Of Pregnancy) Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion. Hegar's sign softening of the lower uterine segment ballottement a sudden tap on the cervix during vaginal examination may cause the fetus to rise in the amniotic fluid and then rebound to its original position. Ballottement is a strong indicator of pregnancy, but may be caused by polyps. uterine souffle soft, blowing sound made by the blood in the arteries of the pregnant uterus and synchronous with the maternal pulse. gravida Refers to pregnancy, primagravida is a first time pregnancy. para Numbers of pregnancies that have ended at 20+ weeks. Abortion/Delivered. fundal height measurement of the size of the uterus

Develop a basic understanding of the prenatal diagnostic tests.

Ultrasound: High-frequency sound waves aimed in a specific direction are deflected by objects in their path and return as echoes. Ultrasound procedures in obstetrics use real-time scanning in which a rapid sequence of fixed images is displayed on the screen, showing movement in body tissues as it happens. Alpha-Fetoprotein Screening: Alpha-fetoprotein (AFP) is the main protein in fetal plasma. AFP can be measured both in maternal serum, and in amniotic fluid. Abnormal concentrations of AFP are associated with serious fetal anomalies. The AFP concentration increases with advancing gestational age of the fetus Multiple-Marker Screening: Analysis of maternal serum for abnormal levels of alpha-fetoprotein, human chorionic gonadotropin, and estriols that may predict chromosomal abnormalities of the fetus; often called triple-screen. Chorionic Villus Sampling: sampling of placental tissue for microscopic and chemical examination to detect fetal abnormalities Amniocentesis: needle puncture of the amniotic sac to withdraw amniotic fluid for analysis Percutaneous Umbilical Blood Sampling: Involves the aspiration of fetal blood from the umbilical cord near the placenta for prenatal diagnosis or therapy. Antepartum Fetal Surveillance: Antepartum fetal surveillance has three goals: to determine fetal health or compromise as accurately as possible, to guide intervention by the obstetric and neonatal teams, and to reduce perinatal morbidity and mortality. Three common methods of fetal surveillance are the nonstress test (NST): which identifies whether an increase in the FHR occurs when the fetus moves, indicating adequate oxygenation , the contraction stress test (CST): a stress test used to evaluate the ability of the fetus to tolerate the stress of labor and delivery , and the biophysical profile (BPP): A test that assess five variables; fetal breathing, fetal movement, fetal tone, amniotic fluid volume, and fetal reaction.