OB/Maternity--ch10-12********

maternal emotional responses

1. ambivalence---the woman feel proud and excited at her achievement while at the same time fearful and anxious of implications. 2. introversion---focusing on oneself, is common during the early part of pregnancy. the woman may withdraw and become increasingly preoccupied with herself and her fetus. as aresult she may participate less with the outside world, and she may appear passive to her family and friends. 3. acceptance---during second trimester, the physcial changes of growing fetus , including enlarging abdomen and fetal movement, bring reality and validity to the pregnancy. 4. mood swings---emotional lability is chracteristic throughout most pregnancies, one moment a woman can feel great joy, and within short time, she feel shock and disbelief. 5. change in body change.

Alpha-fetoprotein Analysis (AFP) a sample of the woman's blood is drawn to evaluate plasma protein that is produced by the fetal liver, yolk sac and GI tract, and crosses from amniotic fluid into the maternal blood.

AFP is a glycoprotein produced initially by the yolk sac and fetal gut, the later predominantly by the fetal liver. in a fetus, the serum AFP level increases until approximately 14-15 weeks, and then falls progressively. in normal pregnancies, AFP from fetal serum enters the amniotic fluid ( in microgram quantities) through fetal urination, fetal gastrointestinal secreations and transudation across fetal membranes (amnion and placenta). the optimal time for AFP screening is 16-18 weeks of gestation. indication: increased levels might indicate a neural tube defect, turner syndrome, tetralogy of fallot, multiple gestation, omphalocele gastroschisis, or hydrocephaly. decreased levels might indicate down syndrome or trisomy 18. from chapter 12: Alpha-fetoprotein ( AFP) IS a glycoprotein produced initially by the yolk sac and fetal gut, and later predominatly by the fetal liver. in normal pregnancies, AFP from fetal serum enters the amnotic fluid ( in microgram quatities ) through fetal urination, gastrointetsional secreations and transudation across fetal membranes if a devlomental defect is present such as failure of neural tube to close, more AFP escape into aminotic fluid fro the fetus. AFP then enters the maternal circulation by crossing the placenta, and the level in maternal serum can be measured. when AFP increase, : open neural tube defect, underestimation of gestational age, low birth weight. when AFP decrease: fetal gestational age is overstimated, fetal death, fetal trisomy 21 ( down syndrome)

Fetal nuchal translucency ( FNT)

Description: An intravaginal ultrasound that measures fluid collection in the subcutaneous space between the skin the skin and the vertical spine of the fetus . Indication: to identify fetal anomalies, abnormal fluid collection can be associated with genetic disorders ( trisomies 13, 18, and 21), Turner syndrome, cardiac deformities, and /or physical anomalies. When the FNT is grater than 2.5mm, the measurement is considered abnormal. Timing Performed between 10 and 14 weeks' gestation. from Chapter 12: increased nuchal translucency is associated with chromosomal abnormalities such as trisomy 21, 18, and 13.

Chorionic villus sampling (CVS)

Description: removal of small tissue specimen from the fetal portion of the placenta, which reflects the fetal genetic makeup, main complications include: severe transverse limb defects and spontaneous pregnancy loss indication: to dectct fetal kayotype, sickle cell anemia, phneylketonuria, down syndrome, duchenne muscular dystrophy, and numerous other genetic disorders. timing: tipically performed between 10 and 12 weeks gestation with results available in less than 1 week. from Chapter 12: cannot be used to detct neural tube defects.

low maternal serum AFP (MSAFP) , estriol , and high hCG level suggest the posbility of what disease? ( THese are marker screening test)

Down syndrome.

Probable signs

braxton hicks contractions postive pregnancy test abnormal enlargement ballottement goodells sign chadwicks sign hegar's sign

chadwick's sign

caused by the vascularization of the cervix. bluish discoloration of the cervix, vagina and labia

physiologic anemia of pregnancy

greater increase in the plasma volume as a result of hormonal factors and sodium and water retention. . becasue the plasma increase excedds the increase of RBC production, normal hemoglobin and hematocrit values decrease. this state of hemodilution is referred to as physiologic anemia of pregnancy.

nonstress test (NST)

indirect measurement of uteroplacemental function. the basis for nonstress test is that normal feetus produces chracteristic fetal heart rate patterns in response to fetal movement. A "reactive" NST includes at least two fetal heart rate accelerations from the basline of at least 15bpm for at least 15 seconds within the 20mins recording period. if the test dosnt meet these criteria after 40 mins, it is consider nonreatice. ........Nonreactive NST is correlated with higher incidence of fetal distress during labor, fetal mortality and IUGR.

Contraction stress test

is a diagnositc procedure performed to determine the fetal heart rate response under stress ( such as during contractions)

Pica

is the compulsive ingestion of nonfood substances.

preconception care

is the promotion of the health and well being of a woman and her partner before pregnancy. the goal of preconception care is to identify and modify biomedical, behavioral and social risks to a woman's health or pregnancy outcome through prevention and management interventions.

AFP, unconjugated estriol , hCG, and inhibin A , together is quad marker test.

low inhibin A levels indicate the possiblity of Down syndrome.

elevated levels of MSAFP are associated with what disease?

open neural tube defects, ventral wall defects, some renal abnormalities, multiple gestation, certain skin disorders, fetal demise, and placental abnormality.

trimester

pregnancy is divided into three trimesters of 13 weeks each.

goodell's sign

softening of the cervix due to vasocongestion.

Braxton hicks contractions

spontaneous irregular, and painless uterus contractions. begins during the first trimester.

linea nigra

the skin in the middle of the abdomen develop a pigmented line, extends from umbilicus to the pubic area. or ( a thin brownish black pigmented line running from the umbilicus to the symphysis pubis, depending on the duration of the pregnancy.)

Hegar's sign

the softening of lower uterine segment results in exaggerated urterine anteflexion during the early months of pregnancy.

Gravid

the state of being pregnant

positive signs

ultrasound verification of embryo or fetus fetal movement felt by experienced clinician ausculation of fetal heart tones via doppler

biophysical profile ( BPP)

uses a real-time ultra sound to allow assessment of various parameters of fetal well-being. a BPP includes ultrasound monitoring of : 1. fetal movements, 2, fetal tone, 3, fetal breathing, 4 amniotic fluid volume . with or without assessment of fetal heart rate. total is 10 points.

Ballottement

when an examiner pushes against the womans cervix during pelvic exmaniation and feels a rebound from the floating fetus

quickening

fetal movement

Para

the number of deliveries at 20 weeks or greater that a woman has, regardless of whether the newborn is born alive or dead. primipara is a woman who has given birth once after a pregnancy of at least 20 weeks multipara : a woman who has had two or more pregnancies resulting in viable offspring. Nullipara is a woman who has not produced a viable offspring.

obstetric history terms ( 5 digit system) GTPAL or TPAL

G= gravida= the current pregnancy to be included in count T=term births=the number of term gestations delivering between 38-42 weeks P=preterm births= the number of preterm pregnancies ending>20 weeks or viability but before completion of 37 weeks. A=abortions= the number of pregnancies ending before 20 weeks or viability L=living children= the number of children currently living.

Preimplantation genetic diagnosis ( PGD)

Description: Genetic testing of embryos produced through in vitro fertilization ( IVF) Identifies embryos carrying specific genetic alterations that can cause disease, and transfer those weithout genetic alterations into the woman's uterus to start a pregnancy. prevents inheritable genetic disease before implantation.

Triple and quad screening tests

Description: Triple screening includes alpha fetoprotein, estriol, and beta hCG; quad screening includes alpha-fetalprotein, estriol, beta-hCG, and inhibin. indication: to Identify risk for Down syndrome, neural tube defects and other chromosomal disorders. Elevated hCG combined with lower-than normal estriol and MSAFP levels indicate increased risk for Down syndrome or other trisomy condition. timing: Performed between 15 and 18 weeks gestation.

Amniocentesis

Amniotic fluid aspirated from the amniotic sac, safety concerns include infection, pregnancy loss and fetal needle injuries. indication: to perform chromosome analysis, alpha-fetoprotein, DNA markers, viral studies, karyotyping; and identify inborn errors of metabolism. Timing: usually performed between 15-20 weeks gestation to allow for adequate amniotic fluid volume to accumulate, results to take 2-4 weeks. from chapter 12: an early amniocentesis is done to detect genetic anomalies. but have high risk spontaneous miscarriage. in second trimester, the procedure is performed between 15 and 20 weeks to detct chromosomal abnormalities. in the thrid trimester, amniocentesis is most commonly indicated to dtermine fetal lung maturity after the 35th week of gestation via analysis of lecithin-to-sphingomyelin ratios.

Level II ultra sound/fetal scan

Description: Use of high-frequency sound waves to visualize the fetus. Indication: Enables evaluation of structural changes to be identified early. Tipically performed after 18 weeks' Gestation.

Gravida

a pregnant woman; gravida I = primigravida, during the first pregnancy. Gravida II (secundigravida) during the second pregnancy.

percutaneous umbilical blood sampling

despricption: insertion of a needle directly into a fetal umbilical vessel under ultrasound guidance; two potential complications : fetal hemorrhage and risk of infection. Indication: Used for prenatal diagnosis of inherited blood disorders such as hemophilia A, karyotyping, detection of fetal infection, determination of acid-base status and assessment and treatment of isoimmunization. timing: Generally performed after 16 weeks gestation.

subjective (presumptive ) symptoms of pregnancy

fatigue breast tenderness nausea and vomiting amenorrhea urinary frequency hyperpigmentation of the skin fetal movement (quickening) uterine enlargment breast enlargement