OB
Conditions of early pregnancy bleeding
"first half of pregnancy"*spontaneous abortion,*uterine fibroids,*ectopic pregnancy,*gestational trophoblastic disease,*cervical insufficiency
Probable signs of pregnancy
(examiners objective findings) Positive pregnancy test, enlarge abdomen uterus, Gooddells signs, chadwick, hegars signs, ballottement, braxtons hicks contractions
Sperm cells and the male hormone testosterone are made in which of the following structures? Select all that apply. Vas deferens Penis Scrotum Ejaculatory ducts Prostate gland Testes Seminiferous tubules Bulbourethral glands
(testes) (seminiferous tubules
Management of Sickle Cell Anemia
*During pregnancy, only supportive therapy is used: blood transfusions for severe anemia, analgesics for pain, and antibiotics for infection Assist the woman in scheduling frequent fetal well-being assessments, such as biophysical profiles, nonstress tests, and contraction stress tests, and monitor laboratory test results for changes
Nursing Management for Heart Disease
*Encourage the client to eat nutritious foods and consume a high-fiber diet to prevent straining and constipation.*Discuss limiting sodium intake if indicated to reduce fluid retention*Monitor her fluid volume carefully to prevent overload
Vaccines contraindicated during pregnancy
*Influenza (live, attenuated vaccine) nasal spray *Measles *Mumps *Rubella *Varicella *BCG (tuberculosis) *Meningococcal *Typhoid
Risk factors for CVD
*hypertension, *high blood cholesterol level, *smoking, *lack of physical activity, and obesity increase the probability of developing CVD.More risk factors for women:Menopause, gestational diabetes, *oral contraceptive use, and bilateral oophorectomy in premenopausal women
Progesterone (progestin)
*maintains the endometrium *decreases the contractility of the uterus *stimulates maternal metabolism and breast development *provides nourishment for the early conceptus (the products of conception after fertilization in the early stages of growth and differentiation)
Conditions of late pregnancy bleeding
*placenta previa, *abruptio placentae, and*placenta accreta, which usually occur after the 20th week of gestation
Acquired heart diseases
- Infective endocarditis - Dysrhythmias - Rheumatic fever - Kawasaki disease - Hypertension - Cardiomyopathies
Autosomal recessive inherited disorders
- both gene pairs are mutated, causing disease sickle cell, cystic fibrosis
education for toxoplasmosis
-avoid eating raw or undercooked meat, especially lamb or pork.Cook all meat to an internal temp of 160F throughout.-Clean cutting boards, work surfaces, and utensils with hot soapy water after contact with raw meat or unwashed fruits and vegetables -Peel/thoroughly wash all raw fruits and vegetables before eating them.-Wash hands thoroughly with warm water and soap after handling raw meat-Avoid feeding cat raw or undercooked meats -Avoid emptying or cleaning the cats litter box (have someone else do it daily)
pathophysiology of gestational diabetes
-hPL (human Placental lactogen) and growth hormone (somatotropin) increase in direct correlation with the growth of placental tissue, RISING THROUGHOUT THE LAST 20 WEEKS OF PREGNANCY TO PROVIDE MORE NUTRIENTS TO THE FETUS + CAUSING INSULIN RESISTANCE (insulin secretion then increases to overcome the resistance of these two hormones.)
HELLP syndrome
-hemolysis, elevated liver enzymes, low platelets -DIC -subcapsular hepatic hematoma 22 and 36 weeks' gestation
Systemic disorders
-lyme disease -systemic lupus erythematosus -scleroderma -purpura -neurofibromatosis
X-linked recessive inheritance
-males show disorder more than females -son cannot inherit disorder from his father
Cytomegalovirus (CMV)
. Can also be spread through vertical transmission from mother to child in utero (causing congenital CMV), during birth, or through breast-feeding *can be found in virtually all body fluids*CMV infection during pregnancy may result in abortion, stillbirth, low birth weight, IUGR, microcephaly, deafness, blindness, intellectual disability, jaundice, or congenital or neonatal infection
Management of Eclampsia
1. Magnesium sulfate 2. Anti-hypertensive agent 3. Deliver fetus left side, oxygen, suction equipment, IV fluids
Varicella Zoster Virus (VZV)
1. causes chickenpox-- and herpes zoster (shingles)*pregnant women are at risk for developing varicella when they come in close contact with children who have an active infection*occurs year round but higher incidence in winter & spring months
Cervical smears
1. detects abnormal pap test (cervical cancer) 2. Infections such as: gonorrhea, chlamydia, or group B streptococcus if POSITIVE, now we give Tx.
chorionic villus sampling (CVS)
10 and 12 weeks' gestation, To detect fetal karyotype, sickle cell anemia, phenylketonuria, Down syndrome, Duchenne muscular dystrophy, and numerous other genetic disorders
Fetal nuchal translucency (FNT)
10 and 14 weeks' gestation 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 greater than 2.5 mm, the measurement is considered abnormal
Triple and quad screening tests
15 and 18 weeks' gestation 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.
Alpha-fetoprotein (AFP)
15 and 18 weeks' gestation, 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
amniocentesis
15 and 20 weeks' gestation To perform chromosome analysis, alpha-fetoprotein, DNA markers, viral studies, karyotyping, and identify inborn errors of metabolism
Percutaneous Umbilical Blood Sampling (PUBS)
16 weeks' gestation 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
Trisomy
3 copies of a chromosome
vaginal/rectal specimens for Group B streptococcus should be cultured at
35-37 wks gestation for presence of the bacterium.
process of glucose tolerance test is typically based on
75g oral glucose load w/o regard to last meal AND MEASURED ONE HOUR LATER: a level of 140mg is abnormal indicating a need for a 3hour glucose tolerance test.
Amniotic fluid is composed of
98% water and 2% organic matter. It is slightly alkaline and contains albumin, urea, bile pigments, renin, glucose, hormones, uric acid, creatinine, bilirubin, lecithin, sphingomyelin, epithelial cells, vernix, and fine hair called lanugo. The composition of amniotic fluid changes with gestation. Adequate amniotic fluid volume is necessary for proper fetal growth and development
Chronic Hypertension
A blood pressure that is equal to or greater than 140/90 mm Hg, which exists prior to pregnancy, occurs before the 20th week of pregnancy, or continues to persist postpartum.complications, including for the fetus or newborn, poor fetal growth, preterm birth, low birth weight, admission to the NICU and death, and for the mother, superimposed preeclampsia/eclampsia, acute renal failure, pulmonary edema, surgical birth, placental abruption, stoke, postpartum cardiomyopathy, and mortality
Group B Streptococcus (GBS)
A common bacterium found in the vagina and rectum of healthy women. However, an infant infected with GBS can develop septicimena, pneumonia, or meningitis.naturally occurring bacterium found in 25% of pregnant women (considered carriers and a risk of colonization of the fetus during birth.
Blastocyst
A fluid-filled sphere formed about 5 days after fertilization of an ovum that is made up of an outer ring of cells and inner cell mass. THis is the structure that implants in the endometrium of the uterus.
Karyotype
A picture of all the chromosomes in a cell arranged in pairs
eating for two
A popular term referring to the eating habits of a pregnant woman, who is said to be eating for two people
luteinizing hormone
A protein hormone secreted by the anterior pituitary that stimulates ovulation in females and androgen production in males.
Placenta
A structure that allows an embryo to be nourished with the mother's blood supply
zona pellucida
A thick, transpartent coating rich in glycoproteins that surrounds an oocyte.
Abruptio Placentae
Abruptio placentae is the premature separation of a normally implanted placenta after the 20th week of gestation prior to birth, which leads to hemorrhage*It typically peaks between 24 and 26 weeks' gestation
Severe (grade 3)
Absent to moderate bleeding (more than 1,500 mL),*severe separation (more than 50%),*profound shock,*dark vaginal bleeding,*agonizing abdominal pain,*decreased maternal blood pressure,*significant maternal tachycardia and development of DIC
Mifepristone (RU-486
Acts as progesterone antagonist, allowing prostaglandins to stimulate uterine contractions; causes the endometrium to slough;*may be followed by administration of misoprostol within 48 hours
X-linked dominant inheritance
All females of the affected father are diseased. Affected mother can pass on the disease to both male and female offspring.
Genome
All the genetic information in an organism; all of an organism's chromosomes.
A feeling expressed by most women upon learning they are pregnant is: Acceptance Depression Jealousy Ambivalence
Ambivalence
Phenotype
An organism's physical appearance, or visible traits.
Effects of Marijuana on pregnancy
Anemia,*inadequate weight gain,* "a motivational syndrome," *hyperactive startle reflex, *newborn tremors, *prematurity, *IUGR
management for Group B streptococcus
Antibiotic therapy (Penicillin G) usually is effective when administered at least 4 hours before birth so it can reach adequate levels in the serum/amniotic fluid to reduce risk of newborn colonization
physiologic anemia of pregnancy
Apparent anemia that results because during pregnancy the plasma volume increases more than the erythrocytes increase.
ischemic phase
Approximately 3 days before menstruation to onset of menstruation
severe preeclampsia management
Assess DTRs to evaluate the effectiveness *Administer parenteral magnesium sulfate as ordered to prevent seizures.Diminished or absent reflexes occur when the client develops magnesium toxicity
Take Note
Assessing the pregnant woman with heart disease for cardiac decompensation is vital because the mother's hemodynamic status determines the health of the fetus.
Class I
Asymptomatic with no limitation of physical activity; no objective evidence of cardiac disease. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or chest pain. **usually can go through pregnancy without complications
Severe Preeclampsia
BP 160/100 or greater, proteinuria greater than 3+, oliguria, elevated serum creatinine- 1.2+, cerebral or visual disturbances (headache or blurred vision), hyperreflexia with ankle clonus, peripheral edema, hepatic dysfunction, RUQ pain, and thrombocytopenia
The nurse is preparing her teaching plan for a woman who has just had her pregnancy confirmed. Which of the following should be included in it? Select all that apply. Prevent constipation by taking a daily laxative Balance your dietary intake by increasing your calories by 300 daily Continue your daily walking routine just as you did before this pregnancy Tetanus, measles, mumps, and rubella vaccines will be given to you now Avoid tub baths now that you are pregnant to prevent vaginal infections Sexual activity is permitted as long as your membranes are intact Increase your consumption of milk to meet your iron needs
Balance your dietary intake by increasing your calories by 300 daily Continue your daily walking routine just as you did before this pregnancy Avoid tub baths now that you are pregnant to prevent vaginal infections Sexual activity is permitted as long as your membranes are intact
(Goodell's sign
Between weeks 6 and 8 of pregnancy, the cervix begins to soften due to vasocongestion and the influence of estrogen.
Bleeding at any time during pregnancy
Bleeding at any time during pregnancy is potentially life threatening*The biggest killer is obstetric hemorrhage
During a clinic visit, a pregnant client at 30 weeks' gestation tells the nurse, "I've had some mild cramps that are pretty irregular. What does this mean?" The cramps are probably: The beginning of labor in the very early stages An ominous finding indicating that the client is about to have a miscarriage Related to over hydration of the woman Braxton Hicks contractions, which occur throughout pregnancy
Braxton Hicks contractions, which occur throughout pregnancy
Which of the following is not true about breast-feeding? Breast-fed infants experience more obesity and allergies Breast milk is perfectly suited to the infant's nutritional needs Breast milk contains maternal antibodies to stimulate infant's immunity Breast-feeding enhances maternal bonding and attachment
Breast-fed infants experience more obesity and allergies
Effects of Sedatives on pregnancy
CNS depression, *newborn withdrawal, *maternal seizures in labor, *newborn abstinence syndrome, *delayed lung maturity
Cardiovascular Disorders
CVD is the leading cause of death for men and women in the United States and is more deadly than all forms of cancer
Cervical Insufficiency (Incompetent Cervix)
Cervical trauma. Some surgical procedures used to treat cervical abnormalities associated with an abnormal Pap smear can result in cervical insufficiency. Race. Black women seem to have a higher risk of developing cervical insufficiency. ... Congenital conditions.
congenital and acquired heart disease
Congenital heart disease often involves structural defects that are present at birth but may not be discovered at that time Complications such as growth restriction, preterm and premature birth, and fetal and neonatal mortality are more common among children of women with congenital heart disease. The risk of complications is determined by the severity of the cardiac lesion, the presence of cyanosis, the maternal functional class, and the use of anticoagulation therapy
Nonstress test:
Demonstrates findings of fetal jeopardy manifested by late decelerations or bradycardia.
Hepatitis B vaccine
Determines if mother has hepatitis B by detecting presence of hepatitis antibody surface antigen (HbsAg) in her blood
Which of the following is the major goal of genetic counseling? Diagnose and determine the role of heredity Reinforce previously presented test data Emphasize good communication skills Offer referral to community support groups
Diagnose and determine the role of heredity
Allele
Different forms of a gene
chromosomal abnormalities
Down syndrome and Turner syndrome
HIV testing
ELISA and Western Blot Detects HIV antibodies and if positive requires more specific testing, counseling, and treatment during pregnancy with antiretroviral medications to prevent transmission to fetus
Possible Factors Contributing to Adolescent Pregnancy
Early menarche*Peer pressure to become sexually active*Sexual or other abuse as a child*Lack of accurate contraceptive information
Group B streptococcus: early onset newborns vs late onset newborns
Early-onset newborns typically present with sepsis/ pneumonia while late-onset infections often manifest with meningitis
perinatal education
Education offered during the childbearing years to expectant families that provide information about pregnancy, preparation for childbearing, family adaptation , and newborn care and development.
Nursing management for Lupus in pregnancy
Emphasize the importance of frequent prenatal visits to detect early preeclampsia, preterm labor, or infections*Teach energy conservation techniques to prevent fatigue, signs and symptoms to report (extreme fatigue, edema, confusion, abdominal pain, weight loss, leg pain, anorexia), and the need for frequent and close monitoring for fetal well-being.
Estrogen
Estrogen is secreted by the ovaries and is crucial for the development and maturation of the follicle. Estrogen is predominant at the end of the proliferative phase, directly preceding ovulation. After ovulation, estrogen levels drop sharply as progesterone dominates. In the endometrial cycle, estrogen induces proliferation of the endometrial glands. Estrogen also causes the uterus to increase in size and weight because of increased glycogen, amino acids, electrolytes, and water. Blood supply is expanded as well.
management for Hepatitis B
Even if previously vaccinated or tested, women should be screened for HbsAg via blood studies.*If woman tests positive for HBV, expect to administer HBIG and the newborn to receive HBV vaccine within 12 hours of birth (2nd/3rd doses given @ 1 + 6 months of age) C section for Hepatitis B will NOT reduce vertical transmission
Follicle-Stimulating Hormone
FSH is secreted by the anterior pituitary gland and is primarily responsible for the maturation of the ovarian follicle. FSH secretion is highest and most important during the first week of the follicular phase of the reproductive cycle.
The predominant anterior pituitary hormones that orchestrate the menstrual cycle include: Thyroid-stimulating hormone (TSH) Follicle-stimulating hormone (FSH) Corticotropin-releasing hormone (CRH) Gonadotropin-releasing hormone (GnRH)
FSH is secreted from the anterior pituitary gland to initiate the development of the ovarian follicles and the secretion of estrogen within the ovarian cycle
Braxton Hicks contractions
False labor; irregular contractions of the uterus that do not intensify or become more frequent as genuine labor contractions do.
Summary of Preembryonic Development
Fertilization takes place in ampulla of the fallopian tube. Union of sperm and ovum forms a zygote (46 chromosomes). Cleavage cell division continues to form a morula (mass of 16 cells). The inner cell mass is called blastocyst, which forms the embryo and amnion. The outer cell mass is called trophoblast, which forms the placenta and chorion. Implantation occurs 7 to 10 days after conception in the endometrium.
Embryonic and fetal development
Full term is technically 40 weeks, but most development is done by 36 weeks
A pregnant client close to term comes into the clinic for an exam. The woman complains about experiencing shortness of breath. The nurse knows that this complaint can be explained as the: Fetus is needing more oxygen now that his/her size is larger. Fundus of the uterus is high and pushing the diaphragm upwards. Woman is experiencing an allergic reaction because of high histamine levels. Oxygen partial pressure concentration is lower in the third trimester.
Fundus of the uterus is high and pushing the diaphragm upwards
Biophysical Risk Factors During Pregnancy
Genetic conditions Chromosomal abnormalities Multiple pregnancy *Defective genesInherited disorders ABO incompatibilityLarge fetal size Medical and obstetric conditions Preterm labor and birth Cardiovascular disease Chronic hypertension Cervical insufficiency Placental abnormalities Infection Diabetes Maternal collagen diseases
Gonadotropin-releasing hormone (GnRH)
GnRH is secreted from the hypothalamus in a pulsatile manner throughout the reproductive cycle. It pulsates slowly during the follicular phase and increases during the luteal phase. GnRH induces the release of FSH and LH to assist with ovulation.
Hepatitis B Virus (HBV)
HBV can be transmitted through contaminated blood, illicit drug use, and sexual contact Acutely infected women develop hepatitis with anorexia, nausea, vomiting, fever, abdominal pain, and jaundice
A nurse is working in a women's health clinic. Which woman would genetic counseling be most appropriate for? Had her first miscarriage at 10 weeks Is 30 years old and planning to conceive Has a history with a close relative with Down syndrome Is 18 weeks pregnant with a normal triple screen result
Has a history with a close relative with Down syndrome
Take Note!
Hemoglobin and hematocrit decrease normally during pregnancy in response to an increase in blood plasma in comparison to red blood cells. *This hemodilution can lead to physiologic anemia of pregnancy, which does not indicate a decrease in oxygen-carrying capacity or true anemia
VACCINE ADMINISTRATION DURING PREGNANCY
Hepatitis B Influenza (inactivated) injection Tetanus/diphtheria (Tdap) Meningococcal Rabies
Habitual abortion
History of three or more consecutive spontaneous abortions *Not carrying the pregnancy to viability or term
A client comes to the clinic for pregnancy testing. The nurse explains that the test detects the presence of which hormone? Human placental lactogen (hPL) Human chorionic gonadotropin (hCG) Follicle stimulating hormone (FSH) Thyroid stimulating hormone (TSH)
Human chorionic gonadotropin (hCG)
When obtaining a blood test for pregnancy, which hormone would the nurse expect the test to measure? Human chorionic gonadotropin (hCG) Human placental lactogen (hPL) Follicle-stimulating hormone (FSH) Luteinizing hormone (LH)
Human chorionic gonadotropin (hCG)
Pathophysiology of GTD
Hydatidiform mole is a benign neoplasm of the chorion in which the chorionic villi degenerate and become transparent vesicles containing clear, viscid fluid
Management of Placenta Previa
If the mother and fetus are both stable, therapeutic management may involve expectant ("wait-and-see" or watchful waiting) care
Environmental Risk Factors During Pregnancy
Infections *Radiation *Pesticides *Illicit drugs *Industrial pollutants *Second-hand cigarette smoke *Personal stress
amnion
Innermost membranous sac surrounding the developing fetus
Incomplete abortion
Intense abdominal cramping *Heavy vaginal bleeding Cervical dilation
varicella/fetus
It can be transmitted to the fetus through the placenta leading to congenital varicella syndrome: occurs in mothers infected during early pregnancy causing low birth weight, skin lesion spontaneous abortions, chorioretinitis, cutaneous scarring, limb hypoplasia, microcephaly, ocular abnormalities, intellectual disability, and early death.
Luteinizing Hormone
LH is secreted by the anterior pituitary gland and is required for both the final maturation of preovulatory follicles and luteinization of the ruptured follicle. As a result, estrogen production declines and progesterone secretion continues. Thus, estrogen levels fall a day before ovulation, and progesterone levels begin to rise.
Three common childbirth education methods
Lamaze (psychoprophylactic), Bradley (partner-coached childbirth), and Dick-Read (natural childbirth).
Which of the following would be considered risk factors for psychologic well-being in pregnancy? Select all that apply: Limited support system and network of friends and family Introverted personality at any point in the pregnancy Ambivalence any time during the pregnancy High levels of stress due to family discord History of previous high-risk pregnancy with complications Depression prior to pregnancy and on medication
Limited support system and network of friends and family High levels of stress due to family discord History of previous high-risk pregnancy with complications Depression prior to pregnancy and on medication
SUMMARY OF MENSTRUAL CYCLE HORMONES
Luteinizing hormone (LH) rises and stimulates the follicle to produce estrogen. As estrogen is produced by the follicle, estrogen levels rise, inhibiting the output of LH. Ovulation occurs after an LH surge damages the estrogen-producing cells, resulting in a decline in estrogen. The LH surge results in establishment of the corpus luteum, which produces estrogen and progesterone. Estrogen and progesterone levels rise, suppressing LH output. Lack of LH promotes degeneration of the corpus luteum. Cessation of the corpus luteum means a decline in estrogen and progesterone output. The decline of the ovarian hormones ends their negative effect on the secretion of LH. LH is secreted, and the menstrual cycle begins again.
Those who may benefit from genetic counseling 1
Maternal age 35 years or older when the baby is born Paternal age 50 years or older Previous child, parents, or close relatives with an inherited disease, congenital anomalies, metabolic disorders, developmental disorders, or chromosomal abnormalities Consanguinity or incest Pregnancy screening abnormality, including alpha-fetoprotein, triple/quadruple screen, amniocentesis, or ultrasound Stillborn with congenital anomalies Two or more pregnancy losses Exposure to drugs, medications, radiation, chemicals, or infection
Effects of Opiates and Narcotics on pregnancy
Maternal and fetal withdrawal, *abruptio placentae, *preterm labor, *premature rupture of membranes, *perinatal asphyxia, *newborn sepsis and death, *intellectual impairment,*malnutrition
A pregnant client's last normal menstrual period was on August 10. Using Nagele rule, the nurse calculates that her estimated due date (EDD) will be which of the following? June 23 July 10 July 30 May 17
May 17
Menopause
Menopause is a universal and irreversible part of the overall aging process involving a woman's reproductive system, after which she no longer menstruates. This naturally occurring phase of every woman's life marks the end of her childbearing capacity. The average age of natural menopause—defined as 1 year without a menstrual period—is 50 to 51 years old
Biophysical Profile (BPP)
Method for evaluating fetal status during the antepartum period based on five variables originating with the fetus: fetal heart rate, breathing movements, gross body movements, muscle tone, and amniotic fluid volume.
Mild (grade 1)
Minimal bleeding (less than 500 mL),*marginal separation (10% to 20%),*tender uterus,*no coagulopathy,*no signs of shock,*no fetal distress
Moderate (grade 2)
Moderate bleeding (1,000 to 1,500 mL),*moderate separation (20% to 50%),*continuous abdominal pain,*mild shock,*normal maternal blood pressure,*maternal tachycardia
mitral valve stenosis
Most common chronic rheumatic valvular lesion in pregnancy.
management for cytomegalovirus
NO PREVENTATIVE VACCINE/THERAPY so it is important to stress good hand hygiene/hygiene practices to reduce transmission of the virus:
aortic stenosis
Narrowing of the opening of the aortic valve, leading to an obstruction to left ventricular ejection *Women with mild disease can tolerate hypervolemia of pregnancy; with progressive narrowing of the opening, cardiac output becomes fixed.
pharmacological management of gestational diabetes: INSULIN
Newer short-acting insulins such as lispro (Humalog) and aspart (NovoLog), which do not cross the placenta, may help reduce postprandial hyperglycemia, episodes of hypoglycemia between meals.*Target fasting glucose values of 60 to 90 mg/dL and 1-hour postprandial values less than 120 mg/dL are necessary to provide good glycemic control
Which of the following biophysical profile findings indicate poor oxygenation to the fetus? Two pockets of amniotic fluid Well-flexed arms and legs Nonreactive fetal heart rate Fetal breathing movements noted
Nonreactive fetal heart rate
Obese Pregnant Woman
Obese pregnant women are a particularly vulnerable group because their disability (obesity) is highly visible.
Rubella titer
Obtained at initial prenatal visit (about 6 weeks gestation)
What is the first step in determining a couple's risk for a genetic disorder?Observing the client and family over time Conducting extensive psychological testing Obtaining a thorough family health history Completing an extensive exclusionary list
Obtaining a thorough family health history
Chronic hypertension with superimposed preeclampsia
Occurs in approximately 20% of pregnant women with increased maternal and fetal morbidity rates
chorion
Outermost layer of the two membranes surrounding the embryo; it forms the fetal part of the placenta.
Perimenopause
Perimenopause or menopausal transition and menopause are biologic markers of the transition from young adulthood to middle age. Neither of these is a symptom or disease, but rather a natural maturing of the reproductive system. During the perimenopausal years (2 to 8 years prior to menopause), women may experience physical changes associated with decreasing estrogen levels, which may include vasomotor symptoms of hot flashes, irregular menstrual cycles, sleep disruptions, forgetfulness, irritability, mood disturbances, weight gain and bloating, irregular menses, headaches, decreased vaginal lubrication, night sweats, fatigue, vaginal atrophy, and depression
Which of the following is an example of an autosomal dominant disorder? Phenylketonuria Tay-Sachs disease Polycystic kidney disease Cystic fibrosis
Polycystic kidney disease
Sociodemographic Risk Factors During Pregnancy
Poverty status*Lack of prenatal careAge younger than 15 years or older than 35 years Parity—All first pregnancies and more than five pregnanciesMarital status—Increased risk for unmarried women Accessibility to health care*Ethnicity—Increased risk in non-White women
Practicing good oral hygiene is important for all women throughout their pregnancy. As a nurse providing anticipatory guidance for pregnant women, what condition can result from periodontal disease if good dental care isn't practiced? Post-dates pregnancy Large for gestational age infant Advanced reproductive cancer Preterm or low-birth-weight infant
Preterm or low-birth-weight infant
Possible Contributing Factors for Ectopic Pregnancy
Previous ectopic pregnancyHistory of sexually transmitted infections (STIs) Fallopian tube scarring from PID*In utero exposure to DES*Endometriosis*Previous tubal or pelvic surgery*Infertility and infertility treatments, including use of fertility drugs*Uterine abnormalities such as fibroids*Presence of intrauterine contraception
Progesterone
Progesterone is secreted by the corpus luteum. Progesterone levels increase just before ovulation and peak 5 to 7 days after ovulation. During the luteal phase, progesterone induces swelling and increased secretion of the endometrium. This hormone is often called the hormone of pregnancy because of its calming effect (reduces uterine contractions) on the uterus, allowing pregnancy to be maintained.
Which hormone is produced in high levels to prepare the endometrium for implantation just after ovulation by the corpus luteum? Estrogen Prostaglandins Prolactin Progesterone
Progesterone is the dominant hormone after ovulation to prepare the endometrium for implantation.
Prostaglandins
Prostaglandins are primary mediators of the body's inflammatory processes and are essential for the normal physiologic function of the female reproductive system. They are a closely related group of oxygenated fatty acids that are produced by the endometrium, with a variety of effects throughout the body. Although they have regulatory effects and are sometimes called hormones, prostaglandins are not technically hormones because they are produced by all tissues rather than by special glands
Assessing Substance Abuse (RAFFT)
R: Do you drink or take drugs to Relax, improve your self-image, or fit in? A: Do you ever drink or take drugs while Alone? F: Do you have any close Friends who drink or take drugs? F: Does a close Family member have a problem with alcohol or drugs? T: Have you ever gotten in Trouble from drinking or taking drugs
Peripartum cardiomyopathy
Rare congestive cardiomyopathy that may arise during pregnancy. Multiparity, age, multiple fetuses, hypertension, an infectious agent, autoimmune disease, or cocaine use may contribute to its presence. Development of heart failure in the last month of pregnancy or within 5 months of giving birth without any preexisting heart disease or any identifiable cause.
During pregnancy, which of the following should the expectant mother reduce or avoid? Raw meat or uncooked shellfish Fresh, washed fruits and vegetables Whole grains and cereals Protein and iron from meat sources
Raw meat or uncooked shellfish
Prevention Education
Reduce risk factors such as sexual intercourse with multiple partners or intercourse without a condom.Avoid contracting STIs that lead to PID.
parity
Refers to the number of pregnancies, not the number of fetuses, carried to the point of viability, regardless of the outcome
Clinical Manifestations of GTD
Report of early signs of pregnancy, such as amenorrhea, breast tenderness, fatigue*Brownish vaginal bleeding/spotting*Anemia*Inability to detect a fetal heart rate after 10 to 12 weeks' gestation*Fetal parts not evident with palpation
Lupus disease
SLE is a chronic, relapsing autoimmune disease of the connective tissues that can affect various organs, such as the skin, joints, kidneys, and serosal membranes Lupus symptoms may include swollen joints, extreme fatigue, oral ulcers, skin rashes, and sensitivity to sunlight
Reva Rubin identified four major tasks that the pregnant woman undertakes to form a mutually gratifying relationship with her infant. What is "binding in"? Ensuring safe passage through pregnancy, labor, and birth Seeking acceptance of this infant by others Seeking acceptance of self as mother to the infant Learning to give of oneself on behalf of the infant
Seeking acceptance of self as mother to the infant
Which glands are located on either side of the female urethra and secrete mucus to keep the opening moist and lubricated for urination? Cowper's Bartholin's Skene's Seminal
Skene's glands are located close to the urethral opening and secrete mucus and lubricate during urination and sexual intercourse.
Psychosocial Risk Factors During Pregnancy
Smoking*Caffeine*Alcohol and substance abuse*Maternal obesity*Inadequate support system*Situational crisis*History of violence*Emotional distress*Unsafe cultural practices
Effects of Alcohol on pregnancy
Spontaneous abortion, inadequate weight gain, IUGR, fetal alcohol spectrum disorder, the leading cause of intellectual disability
Oxytocin (Pitocin)
Stimulates smooth muscle to contract. Helps in birthing process/ expel placenta. Uterus for sperm movement cranially. Udder for milk letdown.
Misoprostol (Cytotec)
Stimulates uterine contractions to terminate a pregnancy;*to evacuate the uterus after abortion to ensure passage of all the products of conception.
Rh(D) immunoglobulin (Gamulin, HydroRho-D, RhoGAM, MICRhoGAM)
Suppresses immune response of nonsensitized Rh-negative clients who are exposed to Rh-positive blood;*to prevent isoimmunization in Rh-negative women exposed to Rh-positive blood after abortions, miscarriages, and pregnancies
Class II:
Symptomatic (dyspnea, chest pain) with increased activity resulting in slight limitation of physical activity.They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. Minimal CVD present.* *usually can go through pregnancy without complications
Class III:
Symptomatic (fatigue, palpitations) with normal activity resulting in marked limitation of physical activity.They are comfortable at rest.Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain.Moderately severe CVD present.**usually have to maintain bedrest during pregnancy
Class IV:
Symptomatic at rest or with any physical activity resulting in inability to carry on any physical activity without discomfort.Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.Severe CVD present.**typically advised to avoid pregnancy
Adolescence
Teens are least likely of all maternal age groups to get early and regular prenatal care
Those who may benefit from genetic counseling 2
Teratogen exposure or risk Concerns about genetic defects that occur frequently in their ethnic or racial group (e.g., those of African descent are most at risk for having a child with sickle cell anemia) Abnormal newborn screening Couples with a family history of X-linked disorders Carriers of autosomal recessive or dominant diseases Child born with one or more major malformations in a major organ system Child with abnormalities of growth Child with developmental delay, intellectual disability, blindness, or deafness
Rh isoimmunization
Term: 300 mg RhoGam at 28 weeks & within 72 hrs delivery 1st trimester abortion: 50 mcg MICRogram
Ovarian Cycle
The 28 days of the menstrual cycle as they apply to events in the ovary. The ovarian cycle has three subphases: the follicular phase, ovulation, and the luteal phase.
Follicular Phase
The follicular phase is a phase in the menstrual cycle during which FSH stimulates the growth of follicles in the ovary, one of which will dominate the others and eventually be the only one growing. During this phase, the growing follicle releases estrogen, which leads to a surge of LH, which triggers ovulation, making the follicle burst and release the ovum into the fallopian tube. The follicular phase also involves the thickening of the uterine walls in preparation for the implantation of a fertilized cell. This entire phase lasts about 10 days.
Sperm maturation and storage in the male reproductive system occur in the: Testes Vas deferens Epididymis Seminal vesicles
The function of the epididymis is to store and mature sperm until ejaculation occurs.
Relaxin
The hormone that increases the flexibility of the pubic symphysis during pregnancy , acts synergistically with progesterone to maintain pregnancy, causes relaxation of the pelvic ligaments, softens the cervix in preparation for birth
Proliferative Phase
The second phase of the uterine (endometrial) cycle, during which the endometrium (shed off during menstration is rebuilt). This phase of the cycle is under the control of estrogen, secreted from the follicle developing in the ovary during this time period. The proliferative phase typically lasts from day 6 to day 14 of the menstrual cycle.
Multiple gestation
The term for more than one fetus in the uterus. Eg. twins, triplets, etc.
Luteal Phase
The third phase of the ovarian cycle, during which a corpus luteum is formed from the remnants of the follicle that has ovulated its oocyte. The corpus luteum secretes progestrone and estrogen during this time period, which typically lasts from day 15 to day 28 of the menstrual cycle. Formation of the corpul luteum is triggered by the same LH surge that triggers ovulation, however in the absence of LH (levels quickly decline after the surge) the corpus luteum begins to degenerate.
Secretory Phase
The third phase of the uterin (endometrial) cycle, during which the rebuilt endometrium is enhanced with glycogen and lipid stores. The secretory phase is primarily under the controll of progestone and estrogen (secreted from the copus luteum during this time period), adn typically lasts from day 15 to day 28 of the menstrual cycle.
fetal stage
The third stage of prenatal development, lasting from two months through birth.
Perinatal drug abuse
The use of alcohol and other drugs by pregnant women
chorionic villi
These are finger like projections that form the fetal portion of the placenta. By the 8th week, chorionic villi sampling is possible.
patho of sickle cell anemia
This abnormal hemoglobin (HbS) becomes "sickle" shaped as a result of any stress or trauma such as infection, fever, acidosis, dehydration, physical exertion, excessive cold exposure, or hypoxia*Microvascular sickling in the placental circulation is associated with miscarriages, placental abruption, preeclampsia, preterm labor, intrauterine growth restriction, fetal distress, and low birth weight
What event occurs during the proliferative phase of the menstrual cycle? Menstrual flow starts Endometrium thickens Ovulation occurs Progesterone secretion peaks
Under the influence of estrogen, the uterine lining (endometrium) thickens and grows in preparation for the implantation of a conceptus if that occurs or to be sloughed off during the menses.
Which of the following is a presumptive sign or symptom of pregnancy? Restlessness Elevated mood Urinary frequency Low backache
Urinary frequency
Inevitable abortion
Vaginal bleeding (greater than that associated with threatened abortion) Rupture of membranes Cervical dilation Strong abdominal cramping Possible passage of products of conception
Threatened abortion
Vaginal bleeding (often slight) early in a pregnancy No cervical dilation or change in cervical consistency Mild abdominal cramping Closed cervic al os No passage of fetal tissue
Nursing Assessment of Vaginal Bleeding
Varying degrees of vaginal bleeding, low back pain, abdominal cramping, and passage of products of conception tissue may be reported.*color of the vaginal bleeding (bright red is significant) and the amoun
Effects of Cocaine on pregnancy
Vasoconstriction ,*gestational hypertension ,*abruptio placentae ,*abortion,*"snow baby syndrome, "CNS defects, IUGR
Effects of Nicotine on pregnancy
Vasoconstriction ,*reduced uteroplacental blood flow, *decreased birth weight,*abortion ,*prematurity, *abruptio placentae, *fetal demise
Effects of Caffeine on Pregnancy
Vasoconstriction and mild diuresis in mother; *fetal stimulation, but teratogenic effects not documented via research
hCG (human chorionic gonadotropin)
What do at-home pregnancy tests detect in urine? preserves the corpus luteum and its progesterone production so that the endometrial lining of the uterus is maintained; this is the basis for pregnancy tests
Mitochondrial inheritance
What pattern of genetic transmission is characterized by no transmission from M, maternal inheritance, and the potential for the disease to affect both sons and daughters of affected F?
Anticipatory guidance regarding sexual activity during pregnancy includes which of the following? Select all that apply: Sexual activity is contraindicated throughout pregnancy Most women don't desire intimacy after the first trimester Sexual activity may continue up until the end of the second trimester Sexual intercourse is prohibited if a history of preterm labor exists Women's sexual desire may change throughout the pregnancy Couples can try a variety of positions of comfort during pregnancy
Women's sexual desire may change throughout the pregnancy Couples can try a variety of positions of comfort during pregnancy
The nurse is counseling a couple, one of whom is affected by an autosomal dominant disorder. They express concerns about the risk of transmitting the disorder. What is the best response by the nurse regarding the risk that their baby may have for the disease? "You have a one in four (25%) chance." "The risk is 12.5%, or a one in eight chance." "The chance is 100%." "Your risk is 50%, or a one in two chance."
Your risk is 50%, or a one in two chance."
Mosaicism
a condition in which cells within the same person have a different genetic makeup.
linea nigra
a dark line appearing on the abdomen and extending from the pubis toward the umbilicus
consequences of toxoplasmosis
a fetus that contracts congenital toxoplasmosis typically has a low birth weight, an enlarged liver and spleen, chorioretinitis, jaundice, IUGR, hydrocephalus, microcephaly, neurologic damage, and anemia.
Toxoplasmosis
a parasite that is most commonly transmitted from pets to humans by contact with contaminated animal feces
Ballottement
a sharp upward pushing against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling the return impact of the displaced fetus
Morula
a solid ball of cells resulting from division of a fertilized ovum, and from which a blastula is formed.
umbilical cord
a tube containing the blood vessels connecting the fetus and placenta
nulligravida
a woman who has never been pregnant
Clinical Triad of Ectopic Pregnancy
abdominal pain,*amenorrhea, and*vaginal bleeding
Preeclampsia
abnormal condition associated with pregnancy, marked by high blood pressure, proteinuria, edema, and headache
Risk factors for Abruptio Placentae
advanced maternal age (over 35 years old), *poor nutrition,*multiple gestation,*excessive intrauterine pressure caused by polyhydramnios,*chronic hypertension,*cigarette smoking,*severe trauma (e.g., auto accident, intimate partner violence),history of abruption in a previous pregnancy, placental abnormalities,cocaine or methamphetamine abuse, thrombophilia,alcohol ingestion, and multiparity
Complete abortion
all products of conception are expelled History of vaginal bleeding and abdominal pain *Passage of tissue with subsequent decrease in pain and significant decrease in vaginal bleeding
Preconception counseling
allows couples to identify and reduce potential pregnancy risks, plan for known risks, and establish early prenatal care.
Blood type incompatibility,
also known as ABO incompatibility, arises when a mother with blood type O becomes pregnant with a fetus with a different blood type (type A, B, or AB).*The mother's serum contains naturally occurring anti-A and anti-B, which can cross the placenta and hemolyze fetal red blood cell
pregestational diabetes
alteration in carbohydrate metabolism identified before conception
Genital herpes
an STD caused by the herpes simplex virus recommends that in the absence of active lesions, a vaginal birth is acceptable, but if the woman has active herpetic lesions near or at term, a cesarean birth might be planned
Pica
an abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay that lasts for at least 1 month
Gestational Diabetes Mellitus (GDM)
any degree of glucose intolerance with onset or first recognition during pregnancy, glucose intolerance with onset during pregnancy usually around 24th week.
Categories of Risk
are biophysical, *psychosocial, *sociodemographic *environmental
X-linked inherited disorders
are those associated with altered genes present on the X chromosome
Presumptive signs
are those signs that the mother can perceive. amenorrhea N/V breast sensitivity fatigue urinary frequency, quickening
Rheumatoid arthritis (RA)
arthritis with swelling, stiffness, pain, and degeneration of cartilage in joints caused by chronic soft tissue inflammation; may result in crippling deformities; an autoimmune disease
Vagina
birth canal; vascularity increases because of the influences of estrogen, resulting in pelvic congestion and hypertrophy of the vagina in preparation for the distention needed for birth. The vaginal mucosa thickens, the connective tissue begins to loosen, the smooth muscle begins to hypertrophy, and the vaginal vault begins to lengthen
major conditions that can complicate a pregnancy
bleeding during pregnancy (spontaneous abortion) *ectopic pregnancy,*gestational trophoblastic disease,cervical insufficiency, placenta previa,abruptio placentae, and placenta accreta), hyperemesis gravidarum,*gestational hypertension,*HELLP syndrome,*gestational diabetes,blood incompatibility, amniotic fluid imbalances (polyhydramnios and oligohydramnios),*multiple gestation,*premature rupture of membranes
The pathologic hallmark of MS
can be described as multicentric, multiphasic central nervous system inflammation with resultant demyelination Uncomplicated MS does not have adverse effects on fertility, labor, or birth*Current medications include anti-inflammatories,
Placenta
carries oxygenated blood to the fetus via the umbilical vein
Estrogen (estriol)
causes enlargement of a woman's breast, uterus, and external genitalia; stimulates myometrial contractility
Gestational trophoblastic disease (GTD)
comprises a spectrum of neoplastic disorders that originate in the placenta*GTDs encompass hydatidiform mole (complete and partial), invasive mole, gestational choriocarcinoma, placental-site trophoblastic tumor, and epithelioid trophoblastic tumor
ductus arteriosus
connects the pulmonary artery to the aorta, bypassing the lungs
foramen ovale
connects the two atria in the fetal heart opening between the right and left atrium
ductus venosus
connects the umbilical vein to the inferior vena cava
Characteristics of FASD
craniofacial dysmorphia (thin upper lip, small head circumference, and small eyes),IUGR, microcephaly, and congenital anomalies such as limb abnormalities and cardiac defects. Long-term sequelae include postnatal growth restriction, attention deficits, delayed reaction time, and poor scholastic performance**Children with prenatal alcohol exposure struggle with cognitive, academic, social, emotional, and behavioral challenges
education for cytomegalovirus prevention
cytomegalovirus prevention -wash hands frequently with soap/water + wear gloves, especially after diaper changes, feeding, wiping nose or drool, and handling children's toys -do not share cups, plates, utensils, food or toothbrushes-do not share towels or washcloths
Missed abortion
death of a fetus or embryo within the uterus that is not naturally expelled after death, :Absent uterine contractions Irregular spotting Possible progression to inevitable abortion
consequences of gestational diabetes
diabetes Consequences: neonatal complications such as macrosomia, hypoglycemia, birth trauma and maternal complications: such as preeclampsia or c-section
normal values for glucose tolerance test
fasting (less than 92) *1 hour = (<180) *2 hour = <150) *3 hour = <140
Normal glucose for non-diabetic pregnant women
fasting = 60-90*1 hour post prandial = 100-120*2 hour post prandial = 60-120
After teaching a group of students about fertilization, the instructor determines that the teaching was successful when the group identifies which as the usual site of fertilization? Fundus of the uterus Endometrium of the uterus Distal portion of fallopian tube Follicular tissue of the ovary
fertilization occurs in the upper portion of the fallopian tube.
preembryonic stage
fertilization through 2nd week
primigravida
first pregnancy
amniotic fluid
fluid within the amniotic sac that surrounds and protects the fetus, help maintain a constant body temperature for the fetus, permit symmetric growth and development, cushion the fetus from trauma, allow the umbilical cord to be relatively free from compression, and promote fetal movement to enhance musculoskeletal development
Genotype
genetic makeup of an organism
Heterozygous
having two different alleles for a trait
Homozygous
having two identical alleles for a trait
HELLP syndrome treatment
immediate delivery
Management of GTD
immediate evacuation of the uterine contents as soon as the diagnosis is made and long-term follow-up of the client to detect any remaining trophoblastic tissue that might become malignant.
high-risk conditions in pregnancy
include gestational diabetes and ectopic pregnancy *Many obstetric complications and conditions are life-threatening emergencies
The nurse teaches the pregnant client how to perform Kegel exercises as a way to accomplish which of the following? Prevent perineal lacerations Stimulate labor contractions Increase pelvic muscle tone Lose pregnancy weight quickly
increase pelvic muscle tone
para
indicates the number of pregnancies reaching viable gestational age (including live births and stillbirths)
Genetic counseling involves
information gathering about birth history, past medical history, and current health status as well as a family history of congenital anomalies, mental retardation, genetic diseases, reproductive history, general health, and causes of death.
Management of obstetric hemorrhage
involves early recognition, assessment, and resuscitation.*Various methods are available to try to stop the bleeding, ranging from:-pharmacologic methods to aid uterine contraction (e.g., oxytocin, ergometrine, and prostaglandins) to -surgical methods to stem the bleeding (e.g., balloon tamponade, compression sutures, or arterial ligation).
Chadwick's sign
is a bluish discoloration of the cervix, vagina, and labia resulting from increased blood flow. It can be observed as early as 6 to 8 weeks after conception, and its presence is an early sign of pregnancy.
Multiple Sclerosis (MS)
is a chronic inflammatory, demyelinating autoimmune disorder of the central nervous system*there is no cure the disease*inflammatory course of MS, autoreactive T cells cross the blood-brain barrier, attacking myelin proteins and leading to inflammation and demyelination
Hegar's sign
is a non-sensitive indication of pregnancy in women — its absence does not exclude pregnancy.
Sickle Cell Anemia (SCA)
is an autosomal recessive inherited condition that results from a defective hemoglobin molecule (hemoglobin S)*adverse maternal outcomes such as preeclampsia, eclampsia, preterm labor, placental abruption, intrauterine growth restriction, low birth weight, and maternal mortalities*Life expectancy is shortened as a consequence of renal damage, cardiac damage, and infection
Goodell's sign
is an indication of pregnancy. It is a significant softening of the vaginal portion of the cervix from increased vascularization.
ectopic pregnancy
is any pregnancy in which the fertilized ovum implants outside the uterine cavity*refers to the implantation of a fertilized egg in a location outside of the uterine cavity, including the fallopian tubes, cervix, ovary, and the abdominal cavity
high-risk pregnancy
is one in which a condition exists that jeopardizes the health of the mother, her fetus, or both.*may result from the pregnancy, or it may be a condition that was present before the woman became pregnant
Lupus and pregnancy
is prone to complications, including flares of disease activity during pregnancy or in the postpartum period, preeclampsia, pregnancy loss, miscarriage, stillbirth, fetal growth restriction, and preterm birth
Stillbirth
is the loss of a fetus after the 20th week of development
Premature rupture of membranes (PROMs)
is the rupture of the bag of waters before the onset of true labor. There are a number of associated conditions and complications, such as infection, prolapsed cord, abruptio placentae, and preterm labor.
Anemia
lack of a normal number of red blood cells This results in reduced capacity of the blood to carry oxygen to the vital organs of the mother and fetus*Clinical symptoms of iron-deficiency anemia include fatigue, diminished quality of life, impaired cognitive function, increased risk for thromboembolic events, headache, restless legs syndrome,
management for gestational diabetes
lifestyle mods,*nutritional changes,*physical activities to focus on TIGHT GLUCOSE CONTROL TO REDUCE LIKELIHOOD OF MACROSOMIA AND AVOID KETOSIS
Management for Severe Preeclampsia
maintain the client on complete bed rest in the left lateral lying position*Report any changes and any complaints of headache or visual disturbances.Offer a high-protein diet with 8 to 10 glasses of water daily
HbA1c levels
measurement of avg glucose levels during past 100-120 days*<7% (good control)*>8 (poor control & warrants intervention)*IF MANAGED IMPROPERLY: congenital malformations (renal, cardiac, skeletal, CNS)
Mesoderm
middle germ layer; develops into muscles, and much of the circulatory, reproductive, and excretory systems
Clinical Manifestations of CVD
mimic common symptoms of late pregnancy, *such as palpitations, *shortness of breath with exertion, and occasional chest pain.* *Few women with heart disease die during pregnancy, but they are at risk for other complications, such as heart failure, arrhythmias, and stroke. Their offspring are also at risk of complications, such as premature birth, low birth weight for gestational age, respiratory distress syndrome, intraventricular hemorrhage, and death
Monosomy
missing a chromosome
Clonus
muscle spasm or twitching, is the presence of rhythmic involuntary contractions, most often at the foot or ankle. Sustained clonus confirms CNS involvement
hyperemesis progresses untreated, it may cause
neurologic disturbances,*renal damage,*dehydration,*ketosis,alkalosis from loss of hydrochloric acid, hypokalemia,*retinal hemorrhage, or*death
management for pregestational diabetes
nutritional management,*exercise,*insulin regimens,*close maternal/fetal surveillance,*ensure effective contraception until stable glycemia is achieved*the goal is to achieve normal fasting glucose' & glycosylated hemoglobin
Maternal risks for abruptio placentae
obstetric hemorrhage,*need for blood transfusions,*emergency hysterectomy,*disseminated intravascular coagulopathy (DIC), and*renal failure**Perinatal consequences include low birth weight, preterm delivery, asphyxia, stillbirth, and perinatal death
gestational diabetes is based on two key components:
on two key components: 1. existence of pancreatic beta-cell dysfunction prior to pregnancy 2.unmasking of this problem by the development of insulin resistance during pregnancy, = requires enhanced insulin production to maintain normal blood glucose ranges)
screening for gestational diabetes
once at first prenatal visit and again at 24-28wks if initial risk assessment is high*An elevated glycosylated hemoglobin is an indicator of gestational diabetes
pharmacological management of gestational diabetes
oral*insulin
trophoblast
outer cells of the blastocyst that secrete enzymes that allow implantation
Ectoderm
outermost germ layer; produces sense organs, nerves, and outer layer of skin
mild preeclampsia
past 20th week, 140/90, 2+/3+ proteinuria,assess for this condition
Hypertension in Pregnancy
preeclampsia-eclampsia, *chronic hypertension, *chronic hypertension with superimposed preeclampsia, and gestational hypertension
-gravida
pregnancy
consequences of Hepatitis B
preterm birth, fetal distress during labor, meconium peritonitis, low birth weight, and neonatal death.
risk factors for gestational diabetes
previous infant w/ congenital anomaly -Hx of gestational diabetes/diabetes -corticosteroids/antipsychotics ->35years -polycystic ovarian syndrome -multiple pregnancy (twins/triplets) -previous infant weighing more than 9 lbs -previous unexplained fetal demise -maternal obesity -hypertension -ethnicity -recurrent monilia infections -polyuria/phagia/dipsia/fatigue -glycosuria/proteinuria**women are at increased risk for preeclampsia and glucose control related complications such as hypoglycemia, hyperglycemia & ketoacidosis
Ovulation
process in which an egg is released from the ovary
Miscarriage
refers to a loss before the 20th week
spontaneous abortion
refers to the loss of a fetus resulting from natural causes, that is, not elective or therapeutically induced by a procedure*the most common complication of early pregnancy
Multifactorial Inheritance Disorders
results from interaction btwn the environment and genetic factors. Very common but unpredictable. Expressed either at birth (cleft lip, clubfoot, congenital disloc of hips & heart defects, pyloric stenosis, urinary tract malformations) or later (hypertension, diabetes mellitus, cancer, psychiatric disorders).
fundus
rounded upper portion of the uterus
Hyperemesis gravidarum
s a severe form of nausea and vomiting of pregnancy*The term morning sickness is often used to describe this condition when symptoms are relatively mild*results in dehydration, weight loss, electrolyte imbalance, and the need for hospitalization*The peak incidence is at 8 to 12 weeks of pregnancy, and symptoms usually resolve by week 20
follicle-stimulating hormone (FSH),
secreted by the pituitary gland to stimulate maturation of the egg cell (ovum)
Complete blood cell count (CBC)
series of tests performed as a group to evaluate several blood conditions
. Menstruation
shedding of the endometrium marks the beginning and end of the monthly cycle. Menopause is the naturally occurring cessation of menstrual cycles.
Pathophysiology for Abruptio Placentae
starts with degenerative changes in the small maternal blood vessels, resulting in blood clotting, degeneration of the decidua (uterine lining), and possible rupture of a vessel. Bleeding from the blood vessel forms a blood clot between the placenta and the uterine wall
Genomics
study of whole genomes, including genes and their functions
Nagele rule for estimated date of delivery
subtract 3 months from the month of their last LMP, add 7 days to the first day of the last normal menstrual period, then correct the year by adding 1 to it. This date is within plus or minus 2 weeks
Wharton's jelly
surrounds the three blood vessels in the umbilical cord to prevent compression, which would choke off the blood supply and nutrients to the growing life inside.
Which of the following fish should be limited in a pregnant woman's diet because of the high mercury content? Salmon Cod Shrimp Sword fish
sword fish
abortion
termination of pregnancy is the loss of an early pregnancy, usually before week 20 of gestation. *can be spontaneous or induced *most common cause for first-trimester abortions is fetal genetic abnormalities, usually unrelated to the mother
Zygote
the fertilized egg; it enters a 2-week period of rapid cell division and develops into an embryo
menarche
the first menstrual period
Quickening
the first movement of the fetus in the uterus that can be felt by the mother
Endoderm
the inner germ layer that develops into the lining of the digestive and respiratory systems
Total placenta previa
the internal cervical os is completely covered by the placenta
Partial placenta previa
the internal os is partially covered by the placenta
Cytomegalovirus (CMV) disease
the most common congenital and perinatal viral infection in the world*is the leading cause of congenital infection*The risk of serious fetal injury is greatest when maternal infection develops in the first trimester or early in the second trimester*It is a leading cause of hearing loss and intellectual disabilityPregnant women acquire active disease primarily from sexual contact, blood transfusions, kissing, and contact with children in daycare centers.
Impact of pregnancy
the most important impact lies in the psychosocial area: it contributes to a loss of self-esteem, societal discrimination, a destruction of life projects, and the maintenance of the circle of poverty
embryonic stage
the period of prenatal development that lasts from the 2nd week until about the 8th week
Marginal placenta previa
the placenta is at the margin or edge of the internal os
low lying placenta previa
the placenta is implanted in the lower uterine segment and is near the internal os but does not reach it
genetic counseling
the process of testing and informing potential parents about their genetic makeup and the likelihood that they will have offspring with genetic defects or hereditary diseases
What factors would change during a pregnancy if the hormone progesterone were reduced or withdrawn? The woman's gums would become red and swollen and would bleed easily The uterus would contract more and peristalsis would increase. Morning sickness would increase and would be prolonged. The secretion of prolactin by the pituitary gland would be inhibited.
the uterus would contract more and peristalsis would increase.
fetal alcohol spectrum disorder (FASD)
this disorder includes the full range of birth defects, such as structural anomalies and behavioral and neurocognitive disabilities caused by prenatal exposure to alcohol
Fetal circulation functions
to carry highly oxygenated blood to vital areas (e.g., heart, brain) while first shunting it away from less important ones (e.g., lungs, liver). The placenta essentially takes over the functions of the lungs and liver during fetal life. As a result, large volumes of oxygenated blood are not needed.
Oligohydramnios
too little amniotic fluid(less than 500 mL) between 32 and 36 weeks' gestation
Polyhydramnios,
too much amniotic fluid more than 2,000 mL) surrounding the fetus between 32 and 36 weeks
Lab & Diagnostic Test
transvaginal ultrasound to visualize the misplaced pregnancy and low levels of serum beta-hCG assist in diagnosing an ectopic pregnancy.
Eclampsia
true toxemia of pregnancy characterized by high blood pressure, Seizure complications can include tongue biting, head trauma, broken bones, and aspiration. albuminuria, edema of the legs and feet, severe headaches, dizziness, convulsions, and coma
Amniotic fluid is derived from
two sources: fluid transported from the maternal blood across the amnion and fetal urine. Its volume changes constantly as the fetus swallows and voids.
Fetal surveillance may include
ultrasound to provide information about fetal growth, activity, and amniotic fluid volume and to validate gestational age. *Alpha-fetoprotein levels may be obtained to detect congenital anomalies such as an open neural tube or ventral wall defects of omphalocele or gastroschisis, *fetal echocardiogram may be necessary to rule out cardiac anomalies
Maternal surveillance may include
urine check for protein (preeclampsia) *urine check for ketones (eating habits) *kidney function every trimester (creatinine/protein) *Eye examination*HbA1c q4-6wks to monitor glucose trends
The nurse is preparing to teach a class to a group of middle-aged women regarding the most common vasomotor symptoms experienced during menopause and possible modalities of treatment available. Common vasomotor symptoms would include which of the following? Chronic fatigue and confusion Forgetfulness and irritability Night sweats and hot flashes Decrease in sexual response and appetite
vasomotor symptoms of menopause are usually described as night sweats and hot flashes.
preterm premature rupture of membranes (PPROM),
which is defined as rupture of membranes prior to the onset of labor in a woman who is less than 37 weeks' gestation
Breast feeding/Hepatitis B
will NOT transmit through breastmilk & is NOT a contraindication (unless on antiviral medication or has bleeding nipples)
multigravida
woman who has been pregnant more than once
human placental lactogen (hPL)
works cooperatively with estrogen and progesterone in preparing the breasts for lactation, and decreases maternal insulin sensitivity to increase its availability for fetal nutrition
Positive signs of pregnancy
xray, ultrasound, auscultation of fetal HR on doppler 10 weeks, examiner (not the mother) palpates fetal movement
Risk Factors of Ectopic Pregnancy
• Previous ectopic pregnancies (strongest risk factor) • Pelvic inflammatory disease (PID)- d.t increase chlymdia infection it is increased • Intrauterine devices (IUD)