OB Exam 1

couvade syndrome

father / partner start feeling pregnancy symptoms (n/v in the morning)

tests done in the third trimester:

fetal movement test (starts at 28 weeks) amniotic fluid index (we want 5 - 25 cm of fluid in there!) nonstress test contraction stress test and BBP profile

lanugo

fine downy hair

palmar grasp reflex

fingers latch onto your fingers

Stages of Labor : dilation

first step, starts with onset of contraction

primigravida

first time pregnant

Assessment schedule :

first ultrasound : 6 - 12 weeks 2nd trimester : 18 - 20 weeks - AFP screening : 16 - 18 fetal movement assessment : every day starting at 28 weeks

Syphilis

goes through the placenta so need antibiotics asap! can cause baby to be preterm, still birth, organ damage

best pelvic shape to have a child?

gynecoid!

SVE

steril vaginal exam

caput succedaneum

swelling on the scalp

when should a parent call a doctor regarding their babies temp?

less than 97.7° F (36.5° C) or greater than 100° F (37.8° C)

step 2 of conception:

ovulation - typically day 14 the egg is released (by a surge of LH)

by how many hours do we expect the first void and bowel movement?

24 hours

APGAR Scoring System :

Appearance (skin color) : blue or pink? Pulse (heart rate) Grimace (reflex irribility) Activity (muscle tone) Respirations (resp effort) crying?

what is the trophoblast's role in pregnancy?

first, they develop into the chorion (outside layer of BOW) then, they send out chorionic villi to get supplies from mom like oxygen and blood.

LMP

last mental period

Stages of Labor : recovery

last stage, restorative, continues for 4 hours after the baby is born.

how long is pregancy

280 days, 10 months, or 40 weeks

Stages of Labor : pushing / delivery

2nd step, starts with complete cervical dilation and ends with delivery of baby

no traveling after :

36 weeks

Newborn normal Measurements: weight

5lb 8 oz - 8lb 14 oz

EDD

estimated delivery date

polydactyly

extra toe or finger

cholestasis of preganacy

extreme itchiness due to the gallbladder being overflowed = waste goes back into the blood. need to be cautious cause this can start preterm labor.

Signs of respiratory distress:

flaring, retractions, grunting, tachypnea

what immunizations can a women receive during pregnancy

flu & Tdap!

nutritional requirements for pregnancy:

folic acid daily (400 - 800mcg) iron supplements daily(27mg) +300 cal /day 8 - 10 eight ounce of fluid

step 1 of conception

follicular phase: varies in length estrogen increases ovarian follicle ripens and starts the journey!

why do amniocentesis and chorionic vili sampling?

for babies that are at risk cause: mom is over 35 couple's earlier child has birth defect abnormal screenings carrier for metabolic disease need to outway benefits from risk

pregnancy brain

forgetfulness, memory decreases, attention decreases and concentration

dyndactyly

fusion of digits

trunk incurvation

galant reflex - kinda hunched over

primipara (primp)

has delivered 1 child before

babies lose heat by:

having less insulating fat and thin skin large body surfaces in relation to mass limited muscle activity cant shiver

Doppler / ultrasound used for:

hear baby's heart beat (110 - 160)

tonic neck

"fenching neck", turn head and put arm out

nevus flammeus

"port wine stain" its a capillary angionoma and they will have it for ife

tests done in 2nd trimester

AFP, amniocentesis , and chronic villus sampling IF NEEDED

mongolian spots

blue spots

coomb's test

looks at mom and babies blood Rh & ABO

preterm

baby before 37 weeks

CLE

continuous lumbar epidural

subjective changes

patient tells us (missed period, fullness in breasts)

episodic breathing

short stop of breathing, more than 15 sec is abnormal

vascular congestion

"pregnancy nose" increases nose bleeds and sensitivity

effects of syphillus on newborns:

"sniffles" discharge out of the nose fever failure to thrive no bridge nose irribility fever

Para

# of delivery experienced that the fetus was over 20 weeks

certified nurse midwife

(CNM) completed post graduate training in the care of normal pregancies and child birth

steps of reviewing a strip from electronic fetal monitoring

1. contraction (frequency & duration 2. baseline for babies hr 3. variability to see how bouncy hr is! we want bouncy 4.presence of accelerations, we want them! (need to be more than 15 sec!!!!)

Breast Feeding Tips :

1. make sure baby is awake 2. get mom in good position 3.bring baby to mom 4. support mom's breast 5. dont want babies lip to curl -> watch for suck 6. set bar low!

Newborn normal Measurements: head circumference

13 - 15 inches

Newborn normal Measurements: length

17 - 22 inches

screening for Clamydia & gonnoreha :

1st prenatal visit, women between ages of 20 - 25, and then people at risk!

Neonatal screening is done before the infant leaves the hospital. When is the ideal time to collect this specimen?

24 hours after the newborn's first protein feeding

Post Partum Assessment: BBUBBLE - EE

Brain - blurry vision? mental status? Breast - soft, not too full Uterus - check fundus (position and if firm) Bladder - last time peed? where is the uterus located? Bowel - last poop? Lochia - discharge? how much? Episiotomy - check incision sites Extremities - homan's DVT Emotional

The nurse is assessing a term newborn. Which finding should the nurse expect when assessing the patterns of sole creases?

Creases on two thirds of the foot

Pregnancy / childbirth mortality causes : HIT

H - hemorrhage I - infection T - toxemia a.k.a preeclampsia

Newborn Vitals :

Pulse : 110 - 160 Resp : 30 - 60 Temp : (axillary) 36.5 - 37.5

TPAL

Term : over 37 weeks Preterm : baby was born before 37 weeks Abortion : baby born before 20 weeks Living : children alive

After water breaks start asking TACO :

Time Amount Color & Odor

Once the cord is clamped what happens to the babies lungs??

pulmonary blood increases, so the lungs are fully supplied, so the baby has now its own oxygenated blood supply.

strok bites

red spots (normally on the eye lids or neck)

call a doctor when your newborn

a temp lower than 37.4 or higher than 36.5 forceful vomitting refusal of feedings lethargic cyanoisis absent breathing for more than 15 sec inconsolable infant discharge or bleeding from cord or circ 2 consecutive green watery stools no wet diapers for more than 18 hours

when should a new born receive their first bath? and why?

after 24 hours, so they can stabilize temperature.

when can we apply sunscreen to an infant?

after 6 months

when do the alveoli develop? surfactant?

alveoli = 24 - 28 weeks surfactant = 28 - 32 weeks

physiologic jaundice

appears after 24 hours, because : relative polycythemia (more red blood cells) red blood cells are being broken down to quickly liver take up bilirubin slowly the intestines reabsorb the bilirubin

central cynaosis

baby blue over trunk = automatic emergency

post term

baby born after 42 weeks *not common because we would just induce the labor

term

baby born from 37 - 42 weeks

stepping

baby tries to step when you hold it up

Male factors in infertility

bad / viable sperm : due to high heat, drug / alch use, cancer treatments, and scaring from STI's

how to help infertility

basal body temp recording! (progesterone spikes temp)! meds to increase ovulations IVF hormone agents to regulate theraputic insemination

doula

birth assistant who provides emotional, physical , and educational support to women and family during child birth and the post partum period.

bilirubin comes from?

broken down red blood cells and heme containing proteins

Pelvic Inflammatory Disease

can cause tubal scaring = infertility may need hospitalization becasue symptoms can become severe.

AFP screening

can tell us if there a neural tube defects and other concerns for the baby best done 16 - 18 weeks

chadwicks sign

cervix is blue/purple = blood flow

goodell's sign

cervix is soft

amniocentesis

checks the amniotic fluid for abnormalities (can detect NTD) done at 15 - 18 weeks

what are prostaglandins

chemical messengers that decrease in number once the cord is clamped, cause shunts to start closing.

cephalhematoma

collection of blood under the membrane (common in vaccum or forcept deliveries)

Types of CAM

complementary, alternative, and integrative

Toco Transducer

contraction monitor (put on the funds)

transient starbismus

crossed eyed because the muscles aren't strong enough

functions of amniotic fluid

cushions, thermal regulation, & insulates from sound.

supine hypotension syndrom (vena caval syndrom)

cutting off blood supply to mom and baby because of the pressure on the aorta and vena cava

surfactant does what?

decreases surface tension, it expands and breaks up the bonds of water so lungs can expand.

hypospadias & epispadias

deformities of the urinary orific for males

multigravida (multip)

delivered 2 or more kids

biophysical profile

detects : babies hr, respirations, movements, tone, and amniotic fluid index we want an 8+ score

heat loss method : conduction

direct transfer of heat from baby to object touching it.

pseudomenstruation

dot of blood on the diaper

heat loss method : convection

heat comes off the baby into the air

heat loss method : radiation

heat goes from babies to another surface

severe hyperbilirubinemia risk factors:

hemolytic disease of newborn (Rh or ABO incompatibilites), significant bruising, and infection

preeclampsia

high blood pressure during pregnancy, NEVER A GOOD SIGN

Barlow & Ortolani movement

hip movement to check range of motion

Gestation

how long the baby has been developing

Gravida

how many times a women has been pregnent

herpes simplex :

if there is an outbreak we need to do c/s start meds for treatment in 3rd trimester but can not 100% go away. shit is for life

complementary therapy

in conjunction with conventional medical treatment

alternative therapy

in place of conventional therapy.

Once the cord is clamped what happens to the placenta?

it stops perfusing so the babies systemic pressure increases.

Cord Care

keep dry and exposed to air only sponge baths falls off around 7 - 10 days check daily for infection

treatment for abnormal cells

loop cryosurgery - freezing laser therapy conization (cone biopsy)

step 3 of conception:

luteal phase - 14 days after ovulation corpus luteum releases progesterone which helps maintian and develop the pregnancy.

Non stress test (NST)

measures fetal wellbeing and oxygenation! looking for 2 OR MORE ACCELERATIONS IN 20 MIN!!!! NONREACTIVE = LESS THEN 2 IN 40 MIN!!!

how to help initiate the babies breathing : mechanical , chemical , and therman/sensory

mechanically, pushing down on the baby during birth helps! chemically - baby is acidotic and breathing balances them out thermal / sensory - coldness & brightness of the room.

zika causes:

microcephaly!!!!! and miscarriage, birth defects of the eyes and nose, impaired growth

nursing care for circumcision:

more benefits then negatives but parents decision, assess sign for hemorrhange or infection, observe first void, and use pertroleum gauze

brachial palsy

nerve damage from shoulder to arm

Nulligravida

never been pregnant

erythema toxicum

newborn rash, for irritation

NSVD

normal spontaneous vaginal delivery

leukorrhea

normal white discharge -> make sure they switch to cotton underwear

infant mortality rate

number of deaths occuring in the childs first 12 months of life.

Neonatal mortality rate

number of new born deaths occurring in the first 28 days of life

pathological jaundice

occurs within the first 24 hours because: decreased available for bilirubin conjugation due to : asphyxia, drugs, hypothermia, hypoglycemia, maternal drugs, and premature babies.

pilonidal dimple

on their back, we want no connection to spinal cord!

Cervix

opening of the uterus, it goes through dilation and effacement (moves into a thinner skin, like turtle neck to tshirt)

Clamydia & gonnoreha can cause:

ophthalmia neonatorum

what is the chorion?

outside layer of BOW

how is the ovary fertilized?

ova fertile for 24 hours ; sperm for 72 when united, they form DIPLOID ZYGOTE! all the other sperm is blocked by "zone pellucida"

female factors in infertility

ovarian disfunction or tubal pathology: scaring from STI's, hormone imbalance, weight issues, chronic illness, drug & alch use

treatment for jaundice

phototherapy - either overhead light or biliblanket that they can do at home or exchnage transfuction of new borns blood

the ballard scoring system evaluates:

physical and neuromuscular maturity

cotyledons

pieces of placenta that form as one, help with metabolic & nutritent exchange.

fetal development stages (3):

pre embryonic : fertilization - 2 weeks embryonic stage : week 2 - 8 fetal stage : 8 weeks - birth!

Vitamin K (phytonadoine)

prophylactic injection of vitamin k given to help the baby with clotting. 0.5 mg given IM in the thigh (vantus lateralis)

Erythromycin Eye Ointment

prophylactic treatment for ophthalmia neonatorum due to gonorrhea and clamydia. - legally required - may be delayed up to 1 hour of life (so mom and baby can bond)

diagnostic changes

prove 100% if pregnant

hCG does what?

sends signals and keeps the corpus leidium alive (keeps it in good standing to hold a baby) also builds and after 5 days, shows up on a pregnancy test.

Abnormal Pap:

shows abnormal cells (atypical squamous, low grade squamous, or high grade squamous cells) so we get a colposcopy!

progesterone causes:

smooth muscle to relax

colposcopy

speculum exam that uses acid solution (vinegar) to identify abnormal cells

Fetal mortality rate

spontaneous death of the fetus anytime during pregnancy

infertility work up:

start least invasive so hormone testing, semen eval, ovarian functin, cervial muscus condition, tubal patency, uterine structure eval.

how does blood flow through a babies heart that is still in utero?

start with the umbilical vein, then ductus venosis (sends a little to liver), right atrium (some blood goes to lungs), then foramen ovale (moves blood from right to left atrium), then ductus arteriosus (helps move blood to aorta), and finally the blood with waste is returned to mom!

nevus vasculosis

strawberry mark, can be raised and a little hairy but eventually go away

round ligament

stretches along with the uterus which can be very painful in later weeks dx: heating pad

babinski

stroke foot, heal to big toe, toes should fan

heat loss method : evaporation

the baby's moisture is absorbed in the air and the heat along with it

how can the mom's body adapt to make and hold 50% more blood?

the progesterone relaxes vessels so mom can take on more blood hr increases to supply blood to baby

Stages of Labor : placenta delivery

third stage

moro reflex

throw hands up and kick feet up

Fundus

top of the uterus, during pregnancy we measure its height. contractions start from here. Palpate after delivery and should be firm.

types of ultrasounds and what they do!:

transabdominal (sees deeper but not sharp) tansvaginal (sharper but less deep) confirm pregnancy and hlp determine gestational age

babies produce & maintain heat by :

try to be in a flexed position to decrease surface area chemical thermogenis - brown adipose tissue that appears 26 - 30 weeks increased metabolism (but need good food supply)

infertility

unable to get pregnant after atlas 1 year of trying

phimosis

unable to retract the foreskin (normal for newborns)

what is normal blood sugar for a baby

under 50, need to contact doctor

VAVD

vacuum assisted vaginal delivery

chorionic vili sampling

vaginally and takes a piece of tissue to determine the enviornment the baby is living in. can not detect NTD done 10 - 13 weeks

estrogen increases:

vascularity!!! more blood flowin

objective changes

we find (braxton hicks contractions, changes in skin pigmentation, enlargement of abdomen)

Contraction stress test (CST) :

we give the patient contractions to see how the uterus, placenta, and baby do! high chance they can go into labor so not done before 37 weeks and patients at risk!

Newborn's weight

weigh at the same time every day, 5 - 10% weight loss is normal more than 10% requires evaluation, birth weight should be back to normal at 2 weeks.

Which measurements were most likely obtained from a normal newborn born at 38 weeks to a healthy mother with no maternal complications?

weight = 3500 g, length = 20 inches (51 cm), head circumference = 34 cm, and chest circumference = 32 cm

lightening

when baby drops down to pelvis

kernicteris / acute bilirubin encephalopathy

when bilirubin is so abundant, it cross over the blood brain barrier

acrocyanosis

when the body color is mostly pink but extremities are a little blue

station

where the baby is in the pelvis, always in relation to the ischial spine. Center is 0, closer to coming out are +

milia

white bumps on nose

epstein's pearl

white cast on the gums (eventually go away)

vernix

white cheesy stuff, helps moisturize the baby

pica

you crave non food items