Childbearing Exam 1
Risks associated with amniocentesis
-miscarriage -infection -club foot if before 15th week of pregnancy
cause of bleeding in third trimester
-placenta previa -abruptio placentae -preterm labor
Maternal complications with Group B Streptococcus
-premature rupture of membranes -preterm labor -chorioamnionitis -sepsis
thyroid changes in first trimester for mom
increased metabolic rate
What would indicate that condoms, either male or female, would be the best recommendation to a client?
"Last year I was diagnosed with HPV"
Braxton Hicks contractions
"practice contractions" serve as warm-up exercises for labor and also play a role in ensuring the placenta receives adequate blood
cervix changes for third trimester for mom
"ripe"
Trisomy 13 Syndrome
(Patau syndrome), the child has an extra chromosome 13 and is severely cognitively challenged Midline body disorders such as cleft lip and palate, heart disorders (particularly ventricular septal defects), and abnormal genitalia are present. Other common findings include microcephaly with disorders of the forebrain and forehead, eyes that are smaller than usual (microphthalmos) or absent, and low-set ears
contraceptive
(a measure to halt conception
Turner Syndrome
(gonadal dysgenesis) has only one functional X chromosome. The child is short in stature and has only streak (small and nonfunctional) ovaries. She is sterile and, with the exception of pubic hair, secondary sex characteristics do not develop at puberty the neck may appear to be webbed and short may be severely cognitively challenged, difficulty in this area is more commonly limited to learning disabilities
Coitus interruptus
(withdrawal) is one of the oldest known methods of contraception. The couple proceeds with coitus until the moment of ejaculation
initial assessments after trauma in pregnancy
*Respiratory system* What is the quality of respirations (labored or even)? What is the respiration rate? Are there sounds of obstruction (wheezing, retractions, coughing)? Does the woman have cyanosis? Does the woman demonstrate oxygen hunger (inability to lie flat, nasal flaring)? *Cardiovascular system* Is her color pale, which could be from hemorrhage? Is there gross bleeding? What is the pulse rate? Increased, which could identify hemorrhage? Or absent, which identifies heart failure? What is the blood pressure (decreases with hemorrhage)? Does the woman feel apprehensive, which can occur with altered vascular pressure? *Neurologic system* Is the woman conscious (able to answer questions coherently)? Are pupils equal and react to light? Are there bruises or bumps on the head or spinal column? Is there loss of motion or sensory function in a body part? *Renal system* Is there bruising over the bladder or on the back over kidneys? Is the urine pink or red, which could identify fresh blood in urine? Or black, which could identify old blood? *Uterine-fetal system* Is there bruising on the abdomen over the uterus? Is there bradycardia, tachycardia, or absence of fetal heart tones? Is there loss of variability on a fetal monitor? Is there evidence of vaginal bleeding? Is there clear fluid leaking from the vagina, which could identify ruptured membranes?
When does pre-eclampsia occur?
- >20 weeks gestation < or = 6 weeks postpartum
Fragile X characteristics
- mental impairment - ADHD - autistic behaviors - long face, large ears, flat feet - hyper-flexible joints - epilepsy -shyness/anxiety -impulsive/challenging behaviors -sensory processing issues
Risk factors for pre-eclampsia
-1st pregnancy -multiple fetal pregnancy - >35 years old -Hx HTN or DM -Family Hx
Symptoms of pre-eclampsia
-HTN -proteinuria -blurred vision -right upper quad pain -edema
How do screening tests differ from diagnostic tests?
-Screening tests are designed to identify those individuals who might benefit from diagnostic testing -Screening tests are usually < 100% positive and false positives occur -Diagnostic tests are highly accurate and designed to predict whether or not there is a problem
characteristics of down syndrome
-broad flat nose -extra fold on eyelid at inner canthus -back of head is flat -short neck -low set ears -poor muscle tone -fingers are short and thick -simian line on palm
who should be referred for genetic testing?
-couples with previous children with congenital disorders or inborn errors of metabolism -couples with close relatives who have genetic disorders -individuals who are known carriers of a chromosomal disorder -individuals with a chromosomal disorder or inborn error of metabolism -consanguineous couples -women older than 35 and men older than 55 -couples of ethnic backgrounds where genetic diseases are known to occur
9 most common signs of pregnancy
-food craving -missed period -morning sickness -altered sense of taste -tender, swollen breasts -fatigue -frequent urination -implantation bleeding or cramping -darkening of areolas
cause of bleeding in second trimester
-gestational trophoblastic disease -premature cervical dilation
Complications of pre-eclampsia
-hemorrhage stroke -placental abruption
Causes of heart palpitations during pregnancy
-increase of blood volume -change in hormones in the body -emotional responses -diseases
high risk pregnancy
-likely to result in failure, harm or injury; having a lot of risk -more likely than others to get a particular disease, condition, or injury
Kidney changes in first trimester for mom
-maternal GFR increasing -glycosuria begins and increases -aldosterone increased, aiding retention of sodium and fluid
Characteristics of Turner syndrome
-wide or weblike neck -small lower jaw -low-set ears and low hairline -broad chest with widely spaced nipples -arms that turn outward at the elbows -short fingers and toes -delayed growth -heart defects
Normal fetal heart rate
110-160
when colostrum begins in breasts
16 weeks
TRIMESTERS by weeks
1st: 1-12 2nd:12-28 3rd:29-40
Ethnocentrism
is the belief one's own culture is superior to all others.
umbilical cord
2 ARTERIES 1 VEIN transport oxygen and nutrients to the fetus from the placenta and to return waste products from the fetus to the placenta
musculoskeletal system
2 weeks of fetal life, cartilage prototypes provide position and support to the fetus. Ossification of this cartilage into bone begins at about the 12th week and continues all through fetal life and into adulthood.
Cardiac output during pregnancy
20-50% increase
What is the best indicator of nutritional health and can identify knowledge deficits
24 hour food intake recall
How long does a pregnancy last
280 days
Gender identity
is the inner sense a person has of being male or female, which may be the same as or different from sex assigned at birth.
How many additional calories/day does a pregnant woman require?
300
Rate of blood flow through cord
350 mL/min
What is GTPAL for pregnant client who had 5 yo at 34 weeks, twins at 32 weeks, and 8 yo at 39 weeks?
4-1-2-0-4
Fetal brain activity can be recorded when?
4-6 weeks gestational age
Blood volume during pregnancy
5,250 ml
glucose challenge test
50-g drank between 24 and 28 weeks gestation to determine if they are at risk for gestational diabetes. If the result of that test is 140 mg/dl (some providers use 130 mg/dl as the cutoff), then the woman will need to do a three hour glucose tolerance test.--> For this, after a fasting glucose sample is obtained, the woman drinks an oral 100-g glucose solution; a venous blood sample is then taken for glucose determination at 1, 2, and 3 hours later. If two of the four blood samples collected for this test are abnormal or the fasting value is above 95 mg/dl, a diagnosis of diabetes is made
protein needs in pregnancy
71g daily
BMI in pregnancy
<18.5 (underweight) gain 28-40 lb 18.5-24.9 (normal) gain 25-35 pounds 25-29.9 (overweight) gain 15-25 pounds greater or equal to 30 (obese) gain 11-20 pounds
post term pregnancy
>42 weeks
Down Syndrome (Trisomy 21)
A genetic disorder caused by the presence of all or part of a third copy of chromosome 21. The nose is broad and flat. The eyelids have an extra fold of tissue at the inner canthus (an epicanthal fold), and the palpebral fissure (opening between the eyelids) tends to slant laterally upward The tongue is apt to protrude from the mouth because the oral cavity is smaller than usual. The back of the head is flat, the neck is short, and an extra pad of fat at the base of the head causes the skin to be so loose it can be lifted easily and so thin it can be revealed on a fetal sonogram The ears may be low set. Muscle tone is poor, giving the newborn a rag doll appearance simian line, a horizontal crease (on hand) seen in children with Down syndrome
sleeping during pregnancy
A good resting or sleeping position is a left-sided Sims position, with the top leg forward. This position puts the weight of the fetus on the bed, not on the woman, and allows good circulation in lower extremities.
Heterosexual
A heterosexual person is someone who finds sexual fulfillment with a member of the opposite gender. Straight is often used in place of heterosexual
Homosexual
A homosexual person is someone who finds sexual fulfillment with a member of his or her own sex. This term is often disparaged in the LGB community. Same-sex partner and gay (for men or women) can be umbrella terms to use instead of homosexual
female condom
A soft, thin plastic tube with two end rings--one to fit over the cervix and one to serve as an anchor outside the entrance to the vagina; also called a vaginal pouch.
standard days method- cycle beads
A woman purchases a circle of beads that helps her predict fertile days. The first bead on the ring is red and marks the first day of her menstrual flow; this is followed by six brown beads which indicate "safe" days. Twelve glow-in-the-dark white beads, which mark fertile days (during which she needs to abstain from coitus), and 13 additional brown "safe" days follow. The woman advances one bead per day during the month.
Multigravida
A woman who has been pregnant previously
Grand multipara
A woman who has carried five or more pregnancies to viability
Multipara
A woman who has carried two or more pregnancies to viability
Primipara
A woman who has given birth to one child past age of viability
Nulligravida
A woman who has never been and is not currently pregnant
Gravida
A woman who is or has been pregnant
Primigravida
A woman who is pregnant for the first time
Drug classification
A= no evidence of fetal risk B= human fetal risk not demonstrated C= no adequate study in humans D= evidence of risk X= definite fetal risk
Liver enzymes that will be elevated when necrosis/hemorrhage of the liver is occurring
AST/ALT
The nurse assess which of the following for evidence of magnesium toxicity?
Absence of a knee-jerk reaction
taboos
Actions not acceptable to a culture
a protein produced by the baby's liver (high levels may indicate neural tube defect or fetus older than originally thought)
Alpha-fetoprotein (AFP)
Test that may be suggested for couples at higher risk for genetic disorders. Also provides DNA for paternity testing
Amniocentesis
test that can diagnose certain birth defects (down syndrome, cystic fibrosis, spina bifida) that is performed at 14 to 20 weeks
Amniocentesis
Chadwicks sign
An increase in the vascularity of the vagina parallels the vascular changes in the uterus. The resulting increase in circulation changes the color of the vaginal walls from their normal light pink to a deep violet CHAD makes us blush ;)
Phenotype
An organism's physical appearance, or visible traits.
Coitus
Another name for sexual relations
Operculum
Another name for the mucus plug
having a balanced diet and adequate water intake (1.5 L or at least 8 glasses)
Discomforts in early pregnancy can be prevented by
Postcoital douching
Douching following intercourse, no matter what solution is used, is ineffective as a contraceptive measure as sperm may be present in cervical mucus as quickly as 90 seconds after ejaculation, long before douching could be accomplished
Only 1 parent needs to carry the mutation for the condition to be passed to child
Autosomal dominant inheritance (tuberous sclerosis, huntington's disease, autosomal dominant polycystic kidney disease)
lithotomy
position for pelvic exam in which the patient lies on his or her back, legs flexed on the thighs, thighs flexed on the abdomen and abducted
Gestational hypertension (GH)
Blood pressure is 140/90 mmHg or systolic pressure elevated 30 mmHg or diastolic pressure elevated 15 mmHg above prepregnancy level; no proteinuria or edema; blood pressure returns to normal after birth
Diagnostic signs of preeclampsia
BP 140-90 Proteinuria Weight Gain
two day method
Based on monitoring and recording cervical secretions After 2 days without secretions you can continue intercourse
Hedger's
Bimanual exam to check for extreme softening of lower uterine segment Hedger's is oh so soft
combines an ultrasound evaluation with a non-stress test (NST) and is intended to determine fetal health during third trimester. Goal is to prevent pregnancy loss and detect low oxygen supply in baby early enough to deliver and not sustain permanent damage
Biophysical profile
Preeclampsia without severe features
Blood pressure is 140/90 mmHg or systolic pressure elevated 30 mmHg or diastolic pressure elevated 15 mmHg above prepregnancy level; proteinuria of 1+ to 2+ on a random sample; weight gain over 2 lb/week in second trimester and 1 lb/week in third trimester; mild edema in upper extremities or face proteinuria (1+ on a urine dip or 300 mg in a 24-hour urine protein collection or 0.3 or higher on a urine protein-creatinine ratio) and a blood pressure rise to 140/90 mmHg, taken on two occasions at least 6 hours apart. nursing interventions: -monitor antiplatelet therapy -promote bed rest -promote good nutrition -emotional support
Preeclampsia with severe features
Blood pressure is 160/110 mmHg; proteinuria 3+ to 4+ on a random sample and 5 g on a 24-hour sample; oliguria (500 ml or less in 24 hours or altered renal function tests; elevated serum creatinine more than 1.2 mg/dl); cerebral or visual disturbances (headache, blurred vision); pulmonary or cardiac involvement; extensive peripheral edema; hepatic dysfunction; thrombocytopenia; epigastric pain nursing interventions: -bed rest -monitor maternal well being -monitor fetal well being -nutritious food -admin drugs to prevent ecclampsia- hypotensive drugs--> hydralazine
Cardiovascular changes in second trimester for mom
Blood pressure slightly decreased
Cardiovascular changes during first trimester for mom
Blood volume increasing Pseudoanemia may occur Clotting factors increasing
is a prenatal test that involves taking a sample of some of the placental tissue for genetic defects
CVS
infection that, in the newborn, causes thrush or oral candidiasis. can also cause penumonia or conjunctivitis
Candida
Ectoderm
Central nervous system (brain and spinal cord) Peripheral nervous system Skin, hair, nails, and tooth enamel Sense organs Mucous membranes of the anus, mouth, and nose Mammary glands
Term for when a vagina and cervix turn bluish
Chadwick
Mask of pregnancy
Cholasma or melasma
Test, usually for women over age 35 or if any inheritable conditions run in family or if they have other abnormal prenatal test, performed at approx. 10-12 weeks to determine whether baby has certain genetic defects
Chorionic Villus Sampling
Stage from fertilization through 14 days or 2 weeks
pre-embryonic stage
Characteristics of Patau syndrome
Cleft lip/palate, polydactyly, heart/brain/kidney defects, most abort due to life span <1 month
creamy white to yellow orange pre-milk fluid
Colostrum
4 types of commonly approved IUDs
Copper T380: ParaGard) is a T-shaped plastic device wound with copper. It is effective for 10 years, after which time it should be removed and replaced with a new IUD. Mirena or Liletta) IUD: which features a drug reservoir of progesterone in the stem. The progesterone (levonorgestrel) in the drug reservoir gradually diffuses into the uterus through the plastic; it both prevents endometrium proliferation and thickens cervical mucus. Because it reduces endometrium proliferation, it also has the potential to reduce endometrial cancer. It is effective for 5 years (possibly as long as 7 years) Skyla) IUD: which is manufactured by the same company as Mirena, has a lower dose of progesterone in the stem. It works similarly to Mirena and is effective for 3 years Kyleena) IUD: which is manufactured by the same company as Mirena, has a lower dose of progesterone in the stem as compared to Mirena but higher than that of Skyla
Rigid, board-like abdomen associated with placental abruption
Couvelaire uterus
recurrent pregnancy loss causes
Defective spermatozoa or ova • Endocrine factors such as lowered levels of protein-bound iodine (PBI), butanol-extractable iodine (BEI), and globulin-bound iodine (GBI); poor thyroid function; or a luteal phase defect • Deviations of the uterus, such as septate or bicornuate uterus • Resistance to uterine artery blood flow • Chorioamnionitis or uterine infection • Autoimmune disorders such as those involving lupus anticoagulant and antiphospholipid antibodies
Reveals important information Creates ethical and personal concerns for parents if an abnormality is discovered
Diagnostic testing
define cultural values
preferred ways of acting based on cultural traditions
Disorder caused by an extra copy of chromosome 21
Down syndrome
Thicker fluid at back of developing baby's neck can be an early sign of
Down syndrome, trisomy 18, or heart problems
Factors that affect fetal development
ETOH Smoking STI's
Eclampsia
Either seizure or coma accompanied by signs and symptoms of preeclampsia are present. nursing interventions: -tonic-clonic seizures: the muscles of the woman's body contract. Her back arches, her arms and legs stiffen, and her jaw closes so abruptly she may bite her tongue. Respirations halt because her thoracic muscles are held in contraction. This phase of the seizure, called the tonic phase, lasts approximately 20 seconds--> clonic) stage, the woman's bladder and bowel muscles contract and relax; incontinence of urine and feces may occur. Although a woman begins to breathe during this stage, the breathing is not entirely effective so she may remain cyanotic. The clonic stage of a seizure lasts up to 1 minute. Following this, she will enter an hour long postictal stage, during which she is unconscious. The priority care for a woman with a tonic-clonic seizure is to maintain a patent airway -birth:
stage from weeks through 8. During this stage all body systems are formed. Greatest risk to environmental teratogens, infections, and drugs at this time
Embryonic stage
HORMONAL CONTRACEPTION AND EFFECT ON PREGNANCY
Estrogen/progestin combination pills (COCs): If a woman taking an estrogen/progestin combination pill suspects she is pregnant, she should discontinue taking any more pills if she intends to continue the pregnancy as high levels of estrogen might be teratogenic to a growing fetus Progestin-impregnated rings or progestin patches: If a woman using a progestin ring or patch becomes pregnant, the progestin should have no effect on a developing fetus. After discontinuing both methods, women become fertile again immediately. Subdermal implants: If a woman becomes pregnant while using a subdermal implant, the rod can be removed; although, because the implant releases only progestin, there should be no effect on the fetus DMPA: like other progestin products, should have no effect if a woman becomes pregnant
Polyhydramnios
Excess amniotic fluid
Lesbian
Female-identified individuals who are sexually attracted to female partners
technique that utilizes a small camera or scope to examine and perform procedures on the fetus during pregnancy
Fetoscopy
Lack of this may result in neural tube defects
Folic acid
Opening in the septum between right and left atrium and ductus arteriosis that connects main pulmonary artery to the aorta
Foramen ovale
x-linked disorder that is the most common cause of cognitive challenge in males
Fragile X
Reveals changes (mutations) in your genes that may cause illness or disease
Genetic testing
This complication in pregnancy can lead to an infant who is large for gestational age and may have a drop in blood sugar after delivery
Gestational diabetes
Term to describe a woman who is pregnant
Gravida
GTPAL
Gravida, Term, Preterm, Abortions, Living G: T: the number of full-term infants born (infants born at 37 weeks or after) P: the number of preterm infants born (infants born before 37 weeks) A: the number of spontaneous miscarriages or therapeutic abortions L: the number of living children
This bacteria is tested for in the third trimester, if present is treated with penicillin during labor
Group B Streptococcus
HELLP is an acronym for this
H-hemolysis E-elevated L-liver enzymes L-low P-platelets
Gynecoid pelvis
Ideal pelvic type for birth
Homozygous
If a person has two like genes for a trait this person is
Barrier Methods and Effect on Pregnancy
If conception should occur while using a barrier method, there is no reason to think the fetus will be affected
Goodells sign
Increased fluid between cells causes it to soften in consistency, and increased vascularity causes it to darken from a pale pink to a violet hue - cervix
pancreas
Increases insulin production but insulin is less effective due to estrogen, progesterone, and other hormones that are antagonists to insulin. This allows for more glucose to be circulating in the maternal blood stream to be available to the fetus.
adrenal glands
Increases levels of corticosteroids and aldosterone inhibit immune response, thereby preventing rejection of fetus
thyroid gland
Increases levels of hormones that increase the basal metabolic rate by 20% and can lead to increased emotional lability, perspiration, tachycardia, and palpitations
pituitary gland
Late in pregnancy produces increased levels of prolactin (milk production); produces oxytocin which is necessary for labor contractions
A copious mucoid fluid with faintly musty odor that occurs in pregnant women
Leukorrhea
line that pregnant women get down the center of the abdomen
Linea Negra
Ectoderm
Lining of pericardial, pleura, and peritoneal cavities Lining of the gastrointestinal tract, respiratory tract, tonsils, parathyroid, thyroid, and thymus glands Lower urinary system (bladder and urethra)
Screening test done at 15 to 20 weeks to detect higher risk of chromosomal disorders and neural tube defects
Maternal serum screen (aka quad screen, triple test, triple screen, multiple marker screen, or AFP)
Teenage pregnancies hold what risks for babies
Low birth weight risk of being abused risk of dying first year
Why epidural is contraindicated with diagnosis of HELLP
Low platelets/risk of bleeding and nerve damage
pregnancy should be avoided for 4 weeks after receiving these vaccines?
MMR and varicella
This medication acts as a central nervous system depressant and smooth muscle relaxer, may be given to pre-eclamptic patients
Magnesium sulfate
Gay
Male-identified individuals who are sexually attracted to male partners. This term is also sometimes used to refer to both men and women who have same-sex partners
Leads to delayed prenatal care, increased risk for HIV/Hep B, STI, and abruptio placentae
Maternal substance abuse
combination oral contraceptives
Monophasic pills, which contain fixed doses of both estrogen and progestin throughout a 21-day cycle • Biphasic, or preparations that deliver a constant amount of estrogen throughout the cycle but varying amounts of progestin • Triphasic and tetraphasic preparations, which vary in both estrogen and progestin content throughout the cycle If the woman is over the age of 21 years and due for a routine exam, a pelvic exam and Pap smear are usually completed at this visit as well
Term to describe a woman who has had more than one pregnancy to fetal viability >20 weeks?
Multigravida
Take the LMP count back 3 months and add 7 days
Naegele's rule
Screen that uses ultrasound to measure thickness of fluid buildup at the back of the developing baby's neck during week 11-14
Nuchal Translucency Screening
Not manufactured by body, integral part of diet for new cell growth
Omega 3 fatty acids
withdrawal
One of the oldest known methods of contraception
Severe eye infection present at birth, can lead to blindness
Ophthalmia neonatorum
Progestin-Only Pills (Mini-Pills)
Oral contraceptives containing only progestins are popularly called mini-pills and, like combination types, must be taken conscientiously every day. Without estrogen content, ovulation may occur, but because the progestins have not allowed the endometrium to develop fully or sperm to freely access the cervix, fertilization and implantation will not take place
oral contraceptives
Oral contraceptives, commonly known as the pill, OCs (for oral contraceptive), or COCs (for combination oral contraceptives), are composed of varying amounts of natural estrogen (17β-estradiol, estradiol valerate) or synthetic estrogen (ethinyl estradiol) combined with a small amount of synthetic progesterone (progestin). The estrogen acts to suppress follicle-stimulating hormone (FSH) and LH to suppress ovulation. The progesterone action causes a decrease in the permeability of cervical mucus and so limits sperm motility and access to ova. Progesterone also interferes with tubal transport and endometrial proliferation to such an extent the possibility of implantation is significantly decreased.
Disorder caused by an extra copy of chromosome 13
Patau syndrome (Trisomy 13)
Bisexual
People are bisexual if they achieve sexual satisfaction from both same-sex and heterosexual relationships
Diagnostic test which examines blood from the fetus to detect fetal abnormalities
Percutaneous Umbilical Cord Blood Sampling (PUBS)
Important things to consider when helping a couple choose a method that will be right for them regarding contraception include:
Personal values • Ability to use a method correctly • If the method will affect sexual enjoyment • Financial factors • If a couple's relationship is short term or long term • Prior experiences with contraception • Future plans
musculoskeletal changes in third trimester for mom
Possible back or pelvic girdle pain
HELLP can be a complication of this pregnancy related illness
Pre-Eclampsia
Nausea and enlarged breasts are what signs of pregnancy?
Presumptive
placenta
Produces estrogen and progesterone (which help maintain the pregnancy) hCG (which allows detection of early pregnancy), and other hormones during pregnancy that impact growth of the baby and uterus and timing and onset of labor
Complete miscarriage
the entire products of conception (fetus, membranes, and placenta) are expelled spontaneously without any assistance
A guaranteed right under Title IV of the Civil Rights Act of 1964
Providing an interpreter
foods to AVOID DURING PREGNANCY
Raw eggs and undercooked chicken (danger of salmonella) • Soft unpasteurized cheese (can harbor Listeria bacteria) • Raw milk • Raw seafood and sushi (can harbor hepatitis A virus) • Cold cuts (deli meats should be heated until steaming to kill any bacteria) • Alcoholic beverages (known to cause fetal alcohol spectrum disorder) • Saccharin (has a long half-life and so can reach toxic levels in a fetus) • Fish with high mercury content such as mackerel and swordfish • Weight loss diets or supplements (women need additional nutrients, not less in pregnancy) • Caffeine (excessive amounts may be a cause of miscarriage, although research is still ongoing)
How would you intervene if your baby begins having late decelerations in the heart rate?
Reposition, IV bolus, stop pitocin, oxygen
The test results from an amniocentesis are most often
valid
Given to Rh-moms to prevent isoimmunization in pregnancy
Rhogam
An ideal contraceptive should be
Safe • Effective • Compatible with spiritual and cultural beliefs and personal preferences of both the user and sexual partner • Free of bothersome side effects • Convenient to use and easily obtainable • Affordable and needing few instructions for effective use • Free of effects (after discontinuation) on future pregnancies
At 37 weeks gestation has a biophysical profile of 9. Which nursing action is best?
Schedule a health care provider appointment for one week
Montgomery's tubercles
Sebaceous glands of the areola of the breast which keep the nipple supple and prevent cracking or drying during lactation, enlarge and become protuberant
Extreme cerebral edema due to elevated blood pressure and subsequent vasoconstriction can lead to this
Seizures; eclampsia
Syphilis
Serology screening (VDRL) or a rapid plasma regain test is done to test for this
What occurs when fetal head delivers but anterior shoulder cannot pass under pubic arch?
Shoulder Dystocia
Which foods are high in folic acid?
Spinach Black eye peas
Dilantin and phenobarbital
St. John's wort can interfere with the action of these
Women can set a start date for a cycle of pills in one of four ways:
Sunday start: Take the first pill on the first Sunday after the beginning of a menstrual flow. • Quick start: Begin pills as soon as they are prescribed. Beginning pills immediately after a prescription is filled may increase compliance, reducing unintended pregnancies. • First day start: Begin pills on the first day of menses. • After childbirth, a woman should start the contraceptive on a day (or Sunday) closest to 2 weeks after birth; after an elective termination of pregnancy, she could begin on a chosen day or the first Sunday after the procedure.
Mesoderm
Supporting structures of the body (connective tissue, bones, cartilage, muscle, ligaments, and tendons) Upper portion of the urinary system (kidneys and ureters) Reproductive system Heart, lymph, and circulatory systems and blood cells
Function of amniotic fluid
Surrounds and protects fetus in uterus
Threatened Miscarriage
Symptoms of a threatened miscarriage begin as vaginal bleeding, initially only scant and usually bright red. A woman may notice slight cramping, but no cervical dilatation is present on vaginal examination. A woman with an apparent threatened miscarriage may be asked to come to the clinic or office to have fetal heart sounds assessed or an ultrasound performed to evaluate the viability of the fetus. Blood may be drawn to test for human chorionic gonadotropin (hCG) hormone at the start of bleeding and again in 48 hours
Torch is an acronym for this
T-toxoplasmosis O-other infections R-rubella C-cytomegalovirus (CMV) H-herpes
symptothermal method of contraception
The MOST RELIABLE periodic abstinence method 1. Combines the cervical mucous and basal body temperature methods
miscarriage
The expulsion of a baby from the mother's body before week 20 of pregnancy
Herpes simplex virus
The first time a woman contracts an HSV infection, systemic involvement occurs. The virus spreads into the bloodstream (viremia) and, if a woman is pregnant, can cross the placenta to a fetus, thus posing substantial fetal risk If genital lesions are present at the time of birth, however, a fetus may contract the virus from direct exposure during birth. For this reason, if a woman has existing genital lesions at the time of birth, cesarean birth is usually advised to reduce the risk of this route of infection Acyclovir (Zovirax) or valacyclovir (Valtrex) can both be safely administered to women who develop lesions during pregnancy as well as to their newborns at birth
para
The number of pregnancies that have reached viability, regardless of whether the infants were born alive
mores or norms
The usual values of a group -expecting women to use prenatal care etc
chorioamnionitis
infection of the fetal membranes and fluid
Reviewing tubal ligation with the client, what is important to point out?
There is a risk the tubes may reconnect by themselves
fetal circulatory system
This system has three shunts 1) Foramen Ovale: Connects the right atrium to the left atrium, bypassing the lungs 2) Ductus arteriosus: Connects the pulmonary artery to the aorta, bypassing the lungs 3) Ductus Venosus: Connects the umbilical vein to the inferior vena cava, bypassing the liver.
Chadwicks
Vagina turns bluish color Chad makes me blush
True or False: HIV positive patients can have a vaginal delivery
True: may have vaginal delivery if viral load is low
Name two interventions for uterine hyperstimulation
Turn off pitocin, oxygen, fluid bolus, side lying position, terbutaline, notify healthcare provider
Rare genetic disorder only found in girls
Turner syndrome
The majority of genetic disorders are inherited as recessive traits. Which best describes these recessive inheritence
Two gens for the disease must be present in an offspring for the disease to occur
Which factor would contribute to high-risk pregnancy?
Type 1 diabetes
side effects and contraindications of diaphragms
Users of diaphragms may experience a higher number of urinary tract infections (UTIs) than nonusers probably because of pressure on the urethra. Diaphragms should not be used in the presence of acute cervicitis, herpes virus infection, or a papillomavirus infection because the close contact of the rubber and the use of a spermicide can cause additional irritation Other contraindications include: • History of toxic shock syndrome (TSS; a staphylococcal infection introduced through the vagina) • Allergy to rubber or spermicides • History of recurrent UTIs
herpes simplex virus type 2
infection that may necessitate a cesarean birth to prevent exposure to the fetus
Lying on the back late in pregnancy compresses what?
Vena cava
Week where fetus nerves and muscles work together; external sex organs now visible; eyelids close to protect the eyes and not open till week 28; head growth has slowed
Week 12
Week where muscle tissue and bone continue to form; skin begins to form; meconium develops in the fetus intestines; begins to make sucking motion with mouth; mom can feel movement
Week 16
Week where baby more active; covered in lanugo; eyebrows, eyelashes, toenails, fingernails have all formed; can hear and swallow
Week 20
Week where bone marrow begins to make blood cells; taste buds form; footprints and fingerprints are formed; real hair on the head begins to grow; lungs are formed but do not work; hand and startle reflex develop; sleeps and wakes regularly; testicles descend; uterus and ovaries are in place
Week 24
Week where bones are fully developed but soft; kicks and jabs are forceful; eyes can open and close and sense change in light; lungs are not fully formed but practice breathing; baby body begins to store vital minerals; lanugo begins to fall off; baby gains weight quickly now
Week 32
Week where vernix gets thicker; body fat increases; movements are less foreceful; baby descends into pelvis
Week 36
Week that baby brain and spinal cord have begun to form; heart begins to form; arm and leg buds appear; baby is now an embryo
Week 4
Week where all organs are fully functioning; baby may turn head down position; full term
Week 40
Week that all major organ and body structures have begun to form; heart is beating regular; arms and legs grow longer and finger and toes form; sex organs begin to form; eyes have moved forward on the face and eyelids have formed; umbilical cord is clearly visible; embryo now fetus
Week 8
Gelatinous substance that prevents pressure of umbilical vein and arteries
Wharton's jelly
abortion
interruption of pregnancy before a fetus is viable
Cultural humility
is a lifelong process of self-reflection and self-critique that begins, not with an assessment of a patient's beliefs, but rather with an assessment of your own
Lactation amenorrhea method (LAM)
When a woman is breastfeeding, there is a natural suppression of both ovulation and menses Lactation amenorrhea method (LAM) is a safe birth control method (a failure rate of about 1% to 5%) if: • An infant is: • Under 6 months of age • Being totally breastfed at least every 4 hours during the day and every 6 hours at night • Receives no supplementary feedings, and • Menses has not returned
What is meconium staining?
When the baby has a bowel movement in utero
Cultural awareness
is being aware cultural differences exist
Cultural competence
is respecting cultural differences or diversity
define cultural specific values
are norms and patterns of behavior unique to one particular culture.
Pica
associated with iron deficiency
Teratogenic
_________ maternal infections involve viral, bacterial, or protozoan organisms which cross the placenta
basal body temperature method
a birth control method based on body temperature changes before and after ovulation
Rh incompatibility
a condition in which antibodies produced by the mother are transmitted to the child, possibly causing brain damage or death occurs when an Rh-negative mother (one negative for a D antigen or one with a dd genotype) carries a fetus with an Rh-positive blood type (DD or Dd genotype) Because people who have Rh-positive blood have a protein factor (the D antigen) that Rh-negative people do not, when an Rh-positive fetus begins to grow inside an Rh-negative mother who is sensitized, her body reacts in the same manner it would if the invading factor were a substance such as a virus—she forms antibodies against the invading substance
Placenta previa
a condition of pregnancy in which the placenta is implanted abnormally in the lower part of the uterus, is the most common cause of painless bleeding in the third trimester of pregnancy
Toxoplasmosis
a disease that results from infection in the gondii parasite
Fragile X Syndrome
a disorder produced by injury to a gene on the X chromosome, producing mild to moderate mental retardation; most common cause of cognitive challenge in males Before puberty, boys with fragile X syndrome may typically demonstrate maladaptive behaviors such as hyperactivity, aggression, or autism. They may have reduced intellectual functioning, with marked deficits in speech and arithmetic Before puberty, boys with fragile X syndrome may typically demonstrate maladaptive behaviors such as hyperactivity, aggression, or autism. They may have reduced intellectual functioning, with marked deficits in speech and arithmetic
Sims
a good resting or sleeping position for pregnant women
Toxoplasmosis
a protozoan infection, is spread most commonly through contact with uncooked meat, although it may also be contracted through handling cat stool in soil or cat litter
male condom
a sheath placed over the penis as a contraceptive and/or to prevent disease transmission
Race
a social construct, refers to a category of people who share a socially recognized physical characteristic, often skin color or facial features. It can also refer to a group of people who share the same ancestry.
cervical mucus method
a type of rhythm method of birth control in which the woman determines when she ovulates by checking her cervical mucus
miscarriage
a viable fetus born more than 20-24 weeks gestation or weighs 500g
primigravida
a woman in her first pregnancy
multipara
a woman who has had one or more children
A pregnant client is lactose intolerant. Which of the following alternative calcium rich foods could this woman consumer? A. Turnip greens B. Green beans C. Cantaloupe D. Nectarines
a. turnip greens
Gestational trophoblastic disease
abnormal proliferation and then degeneration of the trophoblastic villi . As the cells degenerate, they become filled with fluid and appear as clear fluid-filled, grape-sized vesicles. The embryo fails to develop beyond a primitive start. pg 535- dont really get what this is lol
pregnancy losses before 24 weeks (counts as pregnancy so put in gravidity as well)
abortion
Passed to child if both parents have a copy of faulty gene (both are carriers)
autosomal recessive inheritence (cystic fibrosis, sickle cell, thalassaemia, tay-sachs disease)
25-35 lbs
average weight gain during pregnancy
1.5 pounds a month
average weight gain in the first trimester
born between 1940 and 1960 largest generation with financial impact
baby boomers
psychosocial task in second trimester
accepting the baby (move through emotions such as narcissism and introversion as they concentrate on what it will feel like to be a parent. role-playing and increased dreaming are common)
Psychosocial task in first trimester
accepting the pregnancy (common reaction is ambivalence, or feeling both pleased and not pleased about the pregnancy)
Teratogenic drugs
alcohol analgesics antineoplastics-chemo anticonvulants-seizures anticoagulants antidepressants antischizophrenic antithyroid-hypothyroidism antibiotics antivirals ace inhibitors caffeine- low birth weight nicotine narcotics tranquilizers- anxiety live vaccines-rubella vitamin A derivatives- psoriasis
Genome
all of an organism's genetic material
Fertilization
also referred to as contraception and impregnation
Presumptive signs of pregnancy
amenorrhea, fatigue, N/V, breast changes, quickening, urinary frequency
this test can diagnose certain birth defects including down syndrome, cystic fibrosis
amniocentesis
amniotic membranes
amniotic membrane is a dual-walled sac with the chorion as the outmost part and the amnion as the innermost part. The two fuse together as the pregnancy progresses, and by term, they appear to be a single sac they have no nerve supply so when they rupture, the mother or fetus feel any pain
350-400mg
amount of iron the fetus requires per day
Sermicide
an agent that causes death of spermatozoa before they can enter the cervix
spermacides
an agent that causes the death of spermatozoa before they can enter the cervix. It is a chemical barrier method and is often used in combination with other physical barrier methods. Spermicides not only actively kill sperm but also change the vaginal pH to a strong acid level, a condition not conducive to sperm survival
hyperthyroidism
an infant born to a mother with this may appear jittery with tachypnea and tachycardia
Quadruple Screening
analyzes four indicators of fetal health: AFP, unconjugated estriol (UE; an enzyme produced by the placenta that estimates general well-being), hCG (also produced by the placenta), and inhibin A (a protein produced by the placenta and corpus luteum associated with Down syndrome). As with the measurement of MSAFP, quadruple testing requires only a simple venipuncture of the mother.
adolescents
are high risk becaues of incidence of iron deficiency anemia and premature labor
Hegar's sign
extreme softening of the lower uterine segment
Genetic counseling screening should take place when?
before conception
When should women who are trying to conceive stop drinking and smoking
before having sex
walking
best exercise for pregnant women
Cardiovascular changes in third trimester for mom
blood pressure returns to pre-pregnancy levels
presumptive findings of pregnancy
breast changes n/v amennorhea frequent urination fatigue uterine enlargement quickening linea nigra darkened areolas melasma striae gravidium- stretch marks
treatment for ptyalism
brush teeth, drink water, eat right, grab gum
fetal heart rate
can be heard as early as 10-11 weeks 110-160 bpm
smoking
can cause IUGR
infection that causes itching and burning and a white clumpy cheese like discharge
candida-yeast
Define transcultural nursing
care guided by cultural aspects and respects individual differences
Carpal tunnel syndrome
caused by fluid retention during pregnancy creating pressure within the carpal tunnel irritating the median nerve
Cocaine
causes vasoconstriction in the mother leading to compromised placental blood flow
stage from weeks 8 through birth. During this stage all body systems are refined and begin to function
fetal stage
week 1-week 12
first trimester
Test recommended for women with an increased risk of a pregnancy affected with a chromosomal abnormality or if they had an abnormal quad/triple test Picks up DNA out of mothers blood
cell free DNA
Procedure performed between 12-14 weeks gestation for patient diagnosed with incompetent cervix
cerclage
nosebleeds
changes in hormones during pregnancy can also contribute to
A client comes into the unit with placenta previa. What should be the first action by the nurse
check FHT DON'T CHECK PLACENTA (could rupture)
infection that shows almost no external symptoms but may have mucopurulent cervical discharge and cause cervical redness
chlamydia
melasma
chloasma) or the "mask of pregnancy." With the decrease in the level of melanocyte-stimulating hormone after pregnancy, these areas lighten but do not always disappear.
Diaphragm
circular rubber disk that is placed over the cervix before intercourse to mechanically halt the passage of sperm prescribed and fitted initially by a healthcare provider to ensure a correct fit. Because the shape of a woman's cervix changes with pregnancy, miscarriage, cervical surgery (dilatation and curettage [D&C]), or elective termination of pregnancy, teach women to return for a second fitting if any of these circumstances occur. A woman should also have the fit of the diaphragm checked if she gains or loses more than 15 lb because this could also change her pelvic and vaginal contours.
diaphragm
circular rubber disk that is placed over the cervix before sex
Highest priority for a client with preeclampsia and possible eclampsia
clean and maintain an open airway (having a seizure-secure airway)
Marquette model (MM)
combines the use of ovulation detection with other signs of ovulation (cervical mucus, BBT, cervix position and softness) to avoid pregnancy during a woman's fertile period
Live virus vaccines
contraindicated during pregnancy due to being able to cross the placenta and infect fetus
Ovarian changes in first trimester for mom
corpus luteum active
ovarian changes in second trimester for mom
corpus luteum fading
undescended testes
cryptorchidism
Prevention of hemorrhoid
daily bowel evacuation drinking adequate fluids eating adequate fiber resting in sims position
Cri du chat syndrome
deletion of short arm of chromosome 5 abnormal cry, which sounds much more like the sound of a cat than a human infant's cry, children with cri-du-chat syndrome tend to have a small head, wide-set eyes, a downward slant to the palpebral fissure of the eye, and a recessed mandible
intramuscular injections- depot
depot medroxyprogesterone acetate or DMPA (Depo-Provera), a progesterone given every 12 weeks, inhibits ovulation, alters the endometrium, and thickens the cervical mucus so sperm progress is difficult
culture shock
develops when values and beliefs upheld by new culture differ radically from person's native culture
treatment for pyrosis (heartburn)
eat small frequent meals, sleep on left side, don't lie down right away, avoid fatty and caffeine food/drinks
Vitamin C-rich foods
enhances absorption of iron
hormone that contributes to breast development in preparation for lactation and stimulation of uterine growth
estrogen
Schedule of prenatal visits
every 4 weeks through the 28th week and then every 2 weeks through week 36, then every week
hydramnios
excessive amniotic fluid
Ptyalism
excessive salivation
A woman's total body water helps with
exchange of nutrients and supply of excess fluid to replenish is hemorrhage should occur (water almost doubles)
treatment for hypercholesterolemia
exercise daily, eat healthy, limit fats and fried foods
Define stereotyping
expecting a person to act in characteristic way without regard to his or her individual traits
etonogestrel/ethinyl estradiol vaginal ring (NuvaRing)
flexible silicone vaginal ring that, when placed in the vagina, continually releases a combination of estrogen and progesterone inserted vaginally by the woman and left in place for 3 weeks and then removed for 1 week with menstrual bleeding occurring during the ring-free week . The hormones released are absorbed directly by the mucous membrane of the vagina, thereby avoiding a "first pass" through the liver, as happens with COCs; this is an advantage for women with liver disease. Rings do not need to be removed for intercourse. The effectiveness is equal to COCs
the two structures that limit the amount of blood going to the fetal lungs
foreman ovale and ductus arterius
Barrier methods of contraception
forms of birth control that place a chemical or latex barrier between the cervix and advancing sperm so sperm cannot reach and fertilize an ovum
McDonald's Rule
fundal height in cm's equals wks gestation w/in 2 wks
Genotype
genetic makeup of an organism
Preeclampsia s/s
gestational hypertension abdominal or chest pain headach rapid weight gain swelling of face or fingers changes in vision
infection that can cause severe conjunctivitis leading to blindness in newborn
gonorrhea
infection that produces a greenish yellow discharge and extreme inflammation
gonorrhea
Probable signs of pregnancy
goodell's sign, chadwick's sign, hegar's sign, ballottement, positive pregnancy tests (serum, urine), braxton hicks contractions
is or has been pregnant (includes current pregnancy, miscarriages, abortions, and twins/triplets count as one)
gravida
ballottement
he lower uterine segment is tapped sharply during a pelvic exam, the fetus can be felt to bounce or rise in the amniotic fluid up against a hand placed on the abdomen
cephalocaudal
head to tail how development occurs
5 signs of preeclampsia
headache, weight gain, proteinuria, changes in vision, abdominal pain usually right side
Positive signs of pregnancy
hearing fetal heart tones, visualization of the fetus, palpating fetal movement, visualizing fetal movements (anything that can be seen, felt, or heard by the examiner)
Exercise during pregnancy
helps prevent constipation, conditions the body, reduces excessive weight gain, and is associated with a more positive mental state
Complications with miscarriage
hemorrhage infection septic abortion-Infection can occur after a spontaneous miscarriage, but more frequently, it occurs in women who have tried to self-abort or whose pregnancy was aborted illegally using a nonsterile instrument such as a knitting needle (WTF) Isoimmunization- If the fetus was Rh positive and the woman is Rh negative, enough Rh-positive fetal blood may enter the maternal circulation to cause isoimmunization--> production of antibodies against Rh positive blood powerlessness or anxiety
Constipation can lead to
hemorrhoids
Emergency Postcoital Contraception
high-dose estrogen-progestin or progestin-only tablets given within 72 hrs of unprotected intercourse; may be effective up to 5 days after unprotected intercourse; nausea/vomiting common adverse effect postcoital insertion of IUD do not cause abortion; the pills work by inhibiting ovulation and interfering with fertilization by slowing the transport of sperm.
risk of post partum depression
history of depression
oxytocin
hormone that stretches the cervix and stimulates nipples to produce milk, synthetic form can be given to induce labor, accelerate labor, and stop bleeding
hormones produced by the placenta (high levels can indicate risk of a baby with Down's syndrome)
human chorionic gonadotropin (hCG) Inhibin-A
Early gestation, this occurs as number of cell increases. Later, this takes place as existing cells grow
hyperplasia; hypertrophy
Imminent (Inevitable) Miscarriage
if uterine contractions and cervical dilation occur as, with cervical dilation, the loss of the products of conception cannot be halted If no fetal heart sounds are detected and an ultrasound reveals an empty gestational sac or nonviable fetus, her primary healthcare provider may offer medication to help the pregnancy pass or perform a dilatation and curettage (D&C) or a dilation and evacuation (D&E) to ensure all the products of conception are removed
demerol and heroine
impacts intrauterine growth
teratogens- malaria
in humans is caused by intraerythrocytic protozoa of the genus Plasmodium transmitted to humans by the bite of an infected female Anopheles mosquito. Healthcare providers can contact it from infected blood products. During pregnancy, women can transmit malaria to a fetus
Reproductive life planning
includes all the decisions an individual or couple make about whether and when to have children, how many children to have, and how they are spaced.
preeclampsia
increased blood pressure and proteinuria in pregnancy
Preterm labor
labor that occurs before the end of week 37 of gestation A woman is documented as being in actual labor rather than having false labor contractions if contractions have caused cervical effacement over 80% or dilation over 1 cm. tocolytic agent (Terbutaline)- halt contractions- off box use
Probable signs of pregnancy
labratory tests- hCG ballottment-When lower uterine segment is tapped on a bimanual examination, the fetus can be felt to rise against the abdominal wall braxton hicks contractions fetal outline felt by examiner hegars sign- softening of lower uterine segment goodells sign- softening of cervix
Marijuana
leads to fetal growth restrictions and preterm birth
explain use of a diaphragm
leave in place for at least 6 hours after the last time you had sex but don't leave it in for more than 24 hours
Profusion and placental circulation are most effecient when mother lies on
left side (lifts uterus away from inferior vena cava)
Oligohydramnios
less than average amniotic fluid
Term for when the uterus drops as the head of the fetus engages in the pelvis
lightening
Pregnant women should not clean the...
litter box in order to prevent toxoplasmosis
What lab studies would you be most concerned about
low platelets
Android pelvis
lower dimension is extremely narrow and fetus may have difficult time exiting
Cervival Cap
made of soft rubber shaped like a thimble, which fits snugly over the uterine cervix They are contraindicated in any woman who has: • An abnormally short or long cervix • A current abnormal Pap smear • A history of TSS • An allergy to latex or spermicide • A history of cervicitis or cervical infection • A history of cervical cancer • Undiagnosed vaginal bleeding
very effective in preventing unintended pregnancies and STDs
male condoms
Klinefelter syndrome
males with an extra X chromosome At puberty, secondary sex characteristics do not develop; the child's testes remain small and produce ineffective sperm Affected individuals tend to develop gynecomastia (increased breast size) and have an increased risk of male breast cancer.
Risks for Group B Streptococcus
maternal age < 20 prolonged rupture of membranes
Daily Fetal movement count (kick count)
maternal assessment of fetal movement by counting fetal movement in a period of time to identify potentially hypoxic fetuses *Reassuring 10 per hour (quickening) occurs at approximately 18 to 20 weeks of pregnancy and peaks in intensity at 28 to 38 weeks
Green tea
may interfere with the absorption of folic acid
Platypelloid pelvis
pelvis that is flat in its dimensions with a very narrow anterior-posterior diameter and a wide transverse diameter; this shape makes it extremely difficult for the fetus to pass through the bony pelvis
transgender
person is an individual whose gender identity does not match the sex assigned at birth
surfactant
phospholipid substance, is formed and excreted by the alveolar cells of the lungs beginning at approximately the 24th week of pregnancy. This decreases alveolar surface tension on expiration, preventing alveolar collapse and improving the infant's ability to maintain respirations in the outside environment at birth ***24th week
uterine changes for second trimester for mom
placenta producing estrogen and progesterone, steady increased growth
chorionic villus sampling (CVS) takes a sample of
placental tissue
ultrasonography (US)
measures the response of sound waves against solid objects, is a much-used tool for fetal health assessments. It can be used to: • Diagnose pregnancy as early as 6 weeks gestation. • Confirm the presence, size, and location of the placenta and amniotic fluid. • Establish a fetus is growing and has no gross anomalies such as hydrocephalus; anencephaly; or spinal cord, heart, kidney, and bladder concerns. • Establish the sex if a penis is revealed. • Establish the presentation and position of the fetus. • Predict gestational age by measurement of the biparietal diameter of the head or crown-to-rump measurement. • Discover complications of pregnancy, such as the presence of an intrauterine device, hydramnios (excessive amniotic fluid) or oligohydramnios (lessened amniotic fluid), ectopic pregnancy, missed miscarriage, abdominal pregnancy, placenta previa (a low-implanted placenta), premature separation of the placenta, coexisting uterine tumors, or multiple pregnancy. Genetic disorders such as Down syndrome and fetal anomalies such as neural tube disorders, diaphragmatic hernia, or urethral stenosis also can be diagnosed. Fetal death can be revealed by a lack of heartbeat and respiratory movement. • After birth, a sonogram may be used to detect a retained placenta or poor uterine involution in the new mother. helps to have a full bladder before procedure
nonstress test
measures the response of the fetal heart rate to fetal movement. Position the woman and attach both a fetal heart rate and a uterine contraction monitor. Instruct the woman to push the button attached to the monitor (similar to a call bell) whenever she feels the fetus move. This will create a dark mark on the paper tracing at these times
Abortion
medical term for any interruption of a pregnancy before a fetus is viable (i.e., able to survive outside the uterus if born at that time
Cytomegalovirus
member of the HSV family, is another teratogen that can cause extensive damage to a fetus while causing few symptoms in a woman not sexually transmitted but spreads from person to person by droplet infection such as occurs with sneezing If a woman acquires a primary CMV infection during pregnancy and the virus crosses the placenta, the infant may be born with severe neurologic challenges (e.g., hydrocephalus, microcephaly, or spasticity) or with eye damage (e.g., optic atrophy or chorioretinitis), hearing impairment, or chronic liver disease newborns skin may be covered with large petechiae
Group B Strep can lead to
meningitis, pneaumonia, sepsis, cerebral palsy, hearing problems, learning problems, possible seizures
Folic acid deficiency can lead to
midline closure defects such as neural tube disorders
Hydraminos
more than 2,000 ml in total or pockets of fluid larger than 8 cm on ultrasound excessive amniotic fluid
how much fluid in hydramnios?
more than 2000mL
operculum
mucus plug forms to seal out bacteria and help prevent infection in the fetus and membranes
universal taboos
murder, incest, and cannibalism
has been pregnant previosly
mutligravida
Name of rule for baby due date
naegele's rule
Minor body changes during pregnancy
nasal congestion n/v palpitations breast tenderness abdominal discomfort urinary frequemcy leukorrhea SOB backache braxton hicks contractions constipation hemorrhoids muscle cramps variscosities ankle edema
paracentesis
needle aspiration) to assess for bleeding into the abdominal cavity must be done carefully because the bowel, dislocated from its usual position, can be easily punctured
Define prejudice
negative attitude toward members of a group or is an intellectual act
what is the meaning of para?
number of pregnancies that have reached viability
ectopic pregnancy
one in which implantation occurred outside the uterine cavity With most ectopic pregnancy, fertilization occurs as usual in the fallopian tube. Unfortunately, because an obstruction is present, such as an adhesion of the fallopian tube from a previous infection, congenital malformations, scars from tubal surgery, or a uterine tumor pressing on the proximal end of the tube, the zygote cannot travel the length of the tube. It lodges at a strictured site along the tube and implants there instead of in the uterus.
Culdocentesis
or needle aspiration through the posterior vaginal fornix into the peritoneal cavity,
Anthropoid pelvis
oval shaped, with a wider anteroposterior diameter; does not accommodate a fetal head
affects of neonatal herpes
overwhelming infection resulting in damage to CNS, mental retardation, or death
s/s of carpal tunnel syndrome
pain, numbness, tingling and/or weakness in the thumb, fingers, and hand
number of pregnancies that have reached viability
para
Transdermal contraception
patches that slowly but continuously release a combination of estrogen and progesterone. Patches are applied each week for 3 weeks. No patch is applied the fourth week. During the week on which the woman is patch free, a menstrual flow will occur. After the patch-free week, a new cycle of 3 weeks on, 1 week off begins again. T he efficiency of transdermal patches is equal to COCs, although they may be less effective in women who are obese. Because they contain estrogen, they have the same risk for thromboembolic symptoms as COCs
5 contraindications for IUD
pelvic malignancy, vaginal bleeding, pregnancy, pelvic infection, distorted uterine anatomy
Preeclampsia
pregnancy-related disease process evidenced by increased blood pressure and proteinuria The condition tends to occur most frequently in: -women of color; -those with a multiple pregnancy; -primiparas younger than 20 years or older than 40 years of age; -women from low socioeconomic backgrounds (perhaps because of poor nutrition); -those who have had five or more pregnancies; -those who have polyhydramnios (i.e., overproduction of amniotic fluid; -or those who have an underlying disease such as heart disease, diabetes with vessel or renal involvement, and essential hypertension
psychosocial task in third trimester
preparing for the baby and end of pregnancy
number born 24-37 weeks (alive or stillborn) (twins/triplets counts as one)
preterm births
labor that cannot be halted
preterm labor is too far advanced (e.g., membranes have ruptured or the cervix is more than 50% effaced and more than 3 to 4 cm dilated) when they are first seen in a healthcare facility for it to be halted
Possible complications associated with a pregnancy resulting in multiple gestation
preterm labor, cord accident, gestational hypertension, hydramnios, placenta previa, postpartum hemorrhage, twin-twin transfusion, small for gestational age neonates
eating saltines prior to rising
prevent nausea and vomiting by
pregnant for first time
primigravida
given birth to one child past age of viability
primipara
Hormone that increases and maintains the endometrial lining of the uterus during pregnancy and prevents preterm labor
progesterone
Subdermal Hormonal Implant
progestin-filled miniature rod no bigger than a matchstick, etonogestrel implant (Nexplanon) can be embedded just under the skin on the inside of the upper arm where it will slowly release progestin over a period of 3 years inserted as an in-office procedure with the use of a local anesthetic during menses or no later than day 7 of a menstrual cycle to be certain a woman is not pregnant at the time of insertion. It can be placed immediately after an elective termination of pregnancy or 6 weeks after the birth of a baby side effects: weight gain, irregular menstrual cycle (heavy bleeding, spotting, breakthrough bleeding, and amenorrhea), depression, scarring at the insertion site, and need for removal. contraindications: pregnancy, desire to be pregnant within 1 year, and undiagnosed uterine bleeding
musculoskeletal changes in second trimester for mom
progressive cartilage softening Lordosis increasing
Pigmentation in second trimester for mom
progressively increasing
a study conducted by a harvard student 75 mg a day of this is muy bueno
protein
palmer erythema
rash on the surface of the palms some times seen in pregnancy most likely due to increased estrogen levels
oligohydramnios
reduction in the amount of amniotic fluid. can be detected by ultrasound may be caused by kidney dysfunction
Premature cervical dilatation
refers to a cervix that dilates prematurely and therefore cannot retain a fetus until term The dilatation usually occurs painlessly, so often the first symptom is show (a pink-stained vaginal discharge) or increased pelvic pressure, which then is followed by rupture of the membranes and discharge of the amniotic fluid. Uterine contractions begin and, after a short labor, the fetus is born. Unfortunately, this commonly occurs at approximately week 20 of pregnancy, when the fetus is still too immature to survive. *cervical cerclage- surgical procedure that can be performed after 1 loss of child due to this
Gender expression
refers to the behavior a person exhibits, which may or may not be the same as the person's gender identity or sex assigned at birth.
Ethnicity
refers to the cultural group into which a person was born, although the term is sometimes used in a narrower context to mean only race.
Acculturation
refers to the loss of ethnic traditions because of disuse.
culture universal values
refers to values, norms, and patterns shared across almost all cultures.
Abstinence
refraining from sexual relations, has a theoretical 0% failure rate and is also the most effective way to prevent STIs
Fertility awareness
rely on detecting when a woman will be capable of impregnation (fertile) so she can use periods of abstinence during that time
Preterm rupture of membranes
rupture of fetal membranes with loss of amniotic fluid before 37 weeks of pregnancy If rupture occurs early in pregnancy this way, it poses a major threat to the fetus as, after a rupture, the seal to the fetus is lost and uterine and fetal infections may occur Because preterm rupture of membranes is associated with vaginal infection, cultures for Neisseria gonorrhoeae, group B streptococcus, and chlamydia are usually obtained
week 12-week 28
second trimester
Pregnancy-Associated Plasma Protein A
secreted by the placenta; low levels in maternal blood are associated with fetal chromosomal anomalies, including trisomies 13, 18, and 21 or small-for-gestational-age (SGA) babies. A high PAPP-A level may predict an LGA baby.
eclampsia
seizure activity in pregnancy related to high blood pressure
lightening
settling of the fetus into the midpelvis
Syphilis
sexually transmitted infection, is of great concern for the maternal-fetal population If left untreated beyond the 18th week of gestation, hearing impairment, cognitive challenge, osteochondritis, and fetal death are possible.
Chadwick's sign
sign where the color of the vaginal walls change from pink to deep violet
gastrointestinal changes in second trimester for mom
slowed peristalsis
intrauterine device (IUD)
small plastic device that is inserted into the uterus through the vagina. IUDs can be either hormonal or nonhormonal. The device is usually inserted before a woman has had coitus after a menstrual flow, so the healthcare provider can be assured the woman is not pregnant at the time of insertion The device is inserted in a collapsed position and then opens to its final shape in the uterus when the inserter is withdrawn the woman may feel a sharp cramp as the device is passed through the internal cervical os, but she will not feel the IUD after it is in place. Properly fitted, such devices are contained wholly within the uterus, although an attached string protrudes through the cervix into the vagina
vasectomy (male)
small puncture wound (referred to as "no-scalpel technique") is made on the scrotum. The vas deferens on each side are then pulled forward, cut and tied, cauterized, or plugged, blocking the passage of spermatozoa the man can resume sexual intercourse within 1 week, an additional birth control method should be used until two negative sperm reports at about 6 and 10 weeks have been obtained
cervix changes for first trimester for mom
softening begins
cervix changes for second trimester for mom
softening increases
Goodall's
softening of the cervix to almost gooey texture Goodall is ooie gooey good
SE od IUD insertion:
some spotting or uterine cramping the first 2 or 3 weeks after IUD insertion
positive findings of pregnancy
sonographic evidence of fetal outline fetal heart audible fetal movement felt by examiner
First trimester screening cannot detect
spina bifida or other neural tube defects
cause of bleeding in first trimester
spontaneous abortion ectopic pregnancy
Breast changes in 2nd-3rd trimester
steady darkening of nipples and prominent montgomery's glands
uterine changes for third trimester for mom
steady increased growth
uterine changes in first trimester for mom
steady increased growth
striae gravidarum
stretch marks on the abdomen during pregnancy
Maternal Serum α-Fetoprotein
substance produced by the fetal liver that can be found in both amniotic fluid and maternal serum abnormally high if the fetus has an open spinal or abdominal wall defect because the open defect allows more AFP to enter the mother's circulation than usual. Although the reason is unclear, the level is low if the fetus has a chromosomal defect such as Down syndrome
inferior vena cava is compressed by the enlarged uterus, resulting in decreased cardiac output
supine hypotension syndrome
Function of the placenta
supplies fetus with oxygen and nutrients Passes out wastes from fetus
What is lordosis
swayback
Mcdonald's rule
symphysis pubic-fundal height measurement. Should correspond to gestational weeks (if you are 20 weeks then you should measure 20 cm at the umbilicus)
HELLP
syndrome is a variation of gestational hypertension process
number born (alive or stillborn) at 38 weeks gestation onwards (twins/triplets count as one)
term births
Define discrimination
the action of treating people differently based on their physical or cultural traits or is a doing act
Incomplete miscarriage
the fetus dies in utero but is not expelled missed miscarriage is usually discovered at a prenatal examination when the fundal height is measured and no increase in size can be demonstrated or when previously heard fetal heart sounds can no longer be heard. A woman may have had symptoms of a threatened miscarriage (e.g., painless vaginal bleeding) or she may have had no prior clinical symptoms
meconium
the first bowel movement of the newborn The gastrointestinal tract is sterile before birth. Because vitamin K, necessary for blood clotting, is synthesized by the action of bacteria in the intestines, vitamin K levels are almost nonexistent in a fetus and are still low in a newborn (vitamin K is routinely administered intramuscularly at birth)
quickening
the first moment a woman feels fetal movement
quickening
the first movement of the fetus in the uterus that can be felt by the mother
Advanced maternal age
the label for pregnant women 35 years and older at delivery task is generativity—that is, a sense of moving away from themselves and becoming involved with the world or community Inspect her lower extremities thoroughly for varicosities because these are more common in women over age 40 years Because the risk for Down syndrome is higher in older women than in younger women, an incidence of about 1 in 100 compared to 1 in 350 women over 35 years, genetic screening is offered to detect if an open spinal cord or chromosomal defect could be present in the fetus gestational hypertension, preterm or postterm birth, and cesarean birth—are related to the fact that the woman's circulatory system may not be as competent as when she was younger or her body tissues may not be as elastic as they were once
premature separation of the placenta/also called abruptio placentae
the placenta appears to have been implanted correctly. Suddenly, however, it begins to separate and bleeding results because it can lead to extensive bleeding, is the most frequent cause of perinatal death separation generally occurs late in pregnancy; even as late as during the first or second stage of labor. Because premature separation of the placenta may occur during an otherwise normal labor, it is important to always be alert to both the amount and kind of pain and vaginal bleeding a woman is having in labor
Peritoneal lavage
the process of inserting a peritoneal dialysis catheter into the abdominal cavity, adding a quantity of an isotonic solution, aspirating it again, and analyzing it for blood or urine) may reveal bleeding or bladder rupture best.
Advanced
the risk of down syndrome is higher in women of __________ maternal age
define diversity
there is a mixture or variety of sociodemographic groups, experiences and beliefs in a population
week 29-week 40
third trimester
Levothyroxine
this drug should be taken at least 4 hours apart from other medications or products containing iron, calcium or soy
Ovulation Detection
this is an OTC kit. these kits look for LH in the urine 12-24 hours before ovulation.
rubella
this vaccine contains a live virus, can cause congenital anomalies or spontaneous miscarriage in 1st trimester
Trisomy 18 (Edwards Syndrome)
three copies of chromosome 18 These children are severely cognitively challenged and tend to be small for gestational age, have markedly low-set ears, a small jaw, congenital heart defects, and usually misshapen fingers and toes (the index finger deviates or crosses over other fingers). Also, the soles of their feet are often rounded instead of flat (rocker-bottom feet)
left side Sims position
top leg forward, puts weight of fetus on bed and not on woman Improves circulation to lower extremities
This can be found in cat litter, as well as uncooked meat
toxoplasmosis
infections that affect pregnancy
trichomoniasis-protozoal infection candida-yeast gonorrhea chlamydia bacterial vaginosis
tubal ligation
tubal ligation, where the fallopian tubes are occluded by cautery, crushed, clamped, or blocked, thereby preventing passage of both sperm and ova 9.5% effectiveness rate. It also is associated with a decreased incidence of ovarian cancer.
fetal growth
typical fundal (top of the uterus) measurements are: • Over the symphysis pubis at 12 weeks • At the umbilicus at 20 weeks • At the xiphoid process at 36 weeks
cryptorchidism
undescended testicles
Sex assigned at birth
usually based on a person's chromosomal sex: male (XY) or female (XX). There have been cases of individuals born intersex, with ambiguous genitalia, where sex was assigned based on a provider's assessment of the genitalia alone
Rubella (German Measles)
usually causes only a mild rash and mild systemic illness in a woman, but the teratogenic effects on a fetus can be devastating, such as hearing impairment, cognitive and motor challenges, cataracts, cardiac defects (most commonly patent ductus arteriosus and pulmonary stenosis), restricted intrauterine growth (i.e., small for gestational age), thrombocytopenic purpura, and dental and facial clefts, such as cleft lip and palate Typically, a rubella titer from a pregnant woman to estimate whether a woman is susceptible to rubella is obtained on the first prenatal visit A woman who is not immunized before pregnancy CANNOT be immunized during pregnancy because the vaccine contains a live virus that would have effects similar to those occurring with a subclinical case of rubella
fetal gender
usually determined by an ultrasound screen at about 4 months, it can be determined as early as 7 weeks by analysis of maternal serum
Condom
usually made of latex of synthetic sheath
vaginal changes for third trimester for mom
vaginal discharge increase in amount
HELLP syndrome
variation of the gestational hypertensive process named for the common symptoms that occur: Hemolysis leads to anemia • Elevated liver enzymes lead to epigastric pain • Low platelets lead to abnormal bleeding/clotting
fetal heart beat visible and heard when?
visible by vaginal ultrasound: 7-8 weeks heard by doppler: 10-12 weeks
Fundal height (distance from pubic bone to top of uterus) should equal
weeks gestation
1 pound a week
weight gain in second and third trimester
Transgender
when an individual feels their gender and their sex do not match
Cisgender
when an individual feels their gender and their sex match
Polyhydramnios
when there is excess fluid of more than 2,000 ml or an amniotic fluid index above 24 cm can cause fetal malpresentation because the additional uterine space can allow the fetus to turn to a transverse lie. It also can lead to premature rupture of the membranes from the increased pressure, which then leads to the additional risks of infection, prolapsed cord, and preterm birth
transition
when they begin to live as the gender they believe they are
vaginal changes in first trimester for mom
white discharge present
leukorrhea
whitish, viscous vaginal discharge or an increase in the amount of normal vaginal secretions, occurs in response to the high estrogen level and the increased blood supply to the vaginal epithelium and cervix in pregnancy
