exam three

Pedigree

(n.) a list of ancestors, family tree; the history or origins of something

effect of Caffeine on pregnancy

- CNS stimulant -associated with the risk of LBW, miscarriage, and intrauterine growth restriction (IUGR) recommendation: moderate consumption of <200 mg/day does not contribute to miscarriage or preterm birth

NST interpretation

- Reactive: 2 or more FHR accelerations of 15 bpm lasting 15 seconds in a 20 minute period with or without fetal movements **10 bpm lasting 10 seconds if less than 32 weeks gestation -Non Reactive: criteria not met after 40 minutes, do CST or BPP

Couples who have a higher risk for conceiving a child with a genetic disorder include those with...

- a maternal age older than 35 - history of previous pregnancy resulting in a genetic disorder or newborn abnormalities - one or both parents with a genetic disorder - family history of a genetic disorder

CST interpretation

-Negative CST: There are no late decelerations -Positive CST: There are repetitive late decelerations -Equivocal Suspicious: Late decelerations occurring with less than half of uterine contractions -Equivocal Tachysystole: Excessive uterine activity can cause late decelerations -Unsatisfactory: Inadequate contraction pattern or uninterpretable tracing

PUBS (percutaneous umbilical blood sampling)

-Performed second and third trimester from the umbilical vein -Advantage- Direct fetal blood sample (not maternal) (cord blood) -diagnostic: hemophilias, Hemoglobinopathies, Isoimmunization (direct kooms test) and hemolytic disease, hgb &hct, fetal karyotype, infection therapeutic: -Risks: Unable to collect sample, bleeding from the site, PROM, Chorioamnionitis, bradycardia, contractions

List the first trimester signs of pregnancy complications that warrant a call to the physician or emergency visit.

-Persistent and severe vomiting (impairs nutrition). "Hyperemesis gravidarum"- cannot eat anything without vomiting. Often hospitalized to treat diet, give fluids, etc. chills, fever- infection -Burning on urination- urinary tract infection -Diarrhea- dehydration causing preterm labor -Vaginal bleeding- indicate miscarriage -"gush" or fluid- ruptured membranes -Abdominal cramping- miscarriage

contraction stress test (CST)

-Test to identify presence or absence of uteroplacental insufficiency -Indication: NST is Non reactive and no contraindications -contraindications: malpresentation or abnormal location of placenta, extremely premature, only done after NST is nonreactive. -Procedure: Woman is placed on the fetal monitor :Contractions are elicited through nipple stimulation or IV infusion of Pitocin :Need 3 contractions lasting at least 40 sec in 10 minutes period (no more or no less) ***Sometimes called Oxytocin Challenge Test (OCT) if Pitocin used

prenatal testing schedule first trimester

-Ultrasound ( list reasons)-Screen or diagnostic -Chorionic Villus Sampling (CVS)- Fetal tissue, diagnostic -Fetal Nuchal Translucency- screen -Non Invasive Prenatal Screening( NIPS) Cell free DNA, Harmony - Maternal Blood

third trimester screening tests

-Ultrasound (list reasons)-screen or diagnostic -Doppler Flow Studies- Fetal Kick Counts(DFMC)- -Non Stress Test (NST)- -Contraction Stress Test (CST) or Oxytocin Challenge Test(OCT)- -Biophysical Profile (BPP)- -Amniocentesis - Amniotic Fluid, diagnostic

prenatal testing schedule for second trimester

-Ultrasound (list reasons)-screen or diagnostic -Quad Screen Triple Screen(15-20 weeks)- Maternal blood PUBS (Cordocentesis) after 18 weeks- Direct fetal blood, diagnostic Amniocentesis- Amniotic fluid, diagnostic

chorionic villi sampling (CVS)

-a procedure in which a small piece of membrane is removed from the chorion, a layer of tissue that develops into the placenta. -performed at 10-12 weeks gestation -risk factor- bleeding, miscarriage, PROM, chorioamnionitis, or limb abnormalities -trans-abdominal or trans-cervical -if rH negative, Rhogam injection (possibility of maternal fetal blood cross) -advantage: creates a karyotype---early diagnosis and intervention of chromosome and DNA analysis -after 14th week, amniocentesis advised -diagnostic test

Maternal Musculoskeletal Changes

-altered posture and center of gravity. -Altered gate: softened joints and increased joint motility. -Lordosis (increased curvature in the spine. Causes back pain)- compensation for change in center of gravity. -Round ligament spasms (round ligaments in groin area. Weight of fetus pulls down on that). -Diastasis recti. (Separation of abdominal muscles) Discomfort: joint pain, backache, and pelvic pressure, hypermobility of joints. Muscle cramps in the spasms of calf muscle. (reduced levels of diffusible serum Ca++ and/or poor circulation) solve by dorsiflexing the toes. Don't rub it. In addition prenatal vitamins help w calcium too

implantation

-begins around day 6 -trophoblasts (chlorion) secretes enzymes

male sperm count lifestyle factors

-biking, drinking, hot tubs, illicit drugs, hot laptop

effect of cocaine on pregnancy

-causes vasoconstriction. -Maternal effect: hypertension, tachycardia, uterine contractions, PTL, PROM, placenta previa or abruption. -Neonate presents with NAS along with IUGR; LBW, microcephaly, vascular accidents, poor euro-developmental outcomes, poor social interaction skills, sleeping difficulty; feeding difficulties.

maternal changes in endocrine system

-changes in carbohydrate metabolism :all physiology changes occur because of changes in hormonal levels during pregnancy

luteal phase

-corpus luteum is formed from the remnants of the follicle that has ovulated its oocyte. -The corpus luteum secretes progestrone and estrogen until the placenta matures enough to resume function -day 15 to day 28 of the menstrual cycle. -Formation of the corpus 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 if it does not get the signal from fertilized ovum (GcG hormone) and begin menses. --duration of this phase is 14 days and ends when a woman gets her period

secretory phase

-day 15-26 (right after ovulation) -continued swelling and increased secretion of the endometrium (we want it to be thick enough for implantation to occur to become pregant) -if not pregnant: the corpus luteum degenerates, progesterone levels goes fown, and the endometrial lining sloughs off and she gets her menses -ischemia occurs around days 27-28

zygotic stage of development

-day 3-16 cell morula -day 5- blastocyte- embryo blast and trophoblast -multiple gestation -dizygotic -monozygotic -implantation: begins around day 6. trophoblast (chorion) secretes enzymes

Quad screen

-done between 15-20 weeks*** AFP: high levels= neuro tube defect*, low levels: trisomy 21 (downs) *many false positives* estrioles hCG Inhibin A

Non-Invasive Prenatal Screening (NIPS)

-done in first trimester -Maternal serum screen -After pregnancy confirmed -To assess fetal DNA for chromosomal abnormalities -"Harmony" cell free DNA from mother and fetus flow together in the maternal blood stream -Results 8-14 days ( If FISH method used to process results may be even quicker)

physical features of soft signs

-excessive neck at the nape of the neck -separated joints between the bones of the skull (sutures) -small ears -small mouth -wide, short hands with short fingers -white spots on the colored part of the eye -One of the most common genetic causes of intellectual disability. not hereditary.

maternal changes in integumentary system

-hyperpigmentaion: linea nigra (dark pigmentation line from umbilicus to symphysis pubis :chloasma (butterfly mask of pregnancy little rash) -striae- stretch marks -varicosities- increased in blood perfusion causes vein valves to malfunction -hot flashes and facial flushing -sweating/ hot flashes -oily skin and acne

function of estrogen during pregnancy

-inhibits FSH secretion (she doesnt need a monthly ovarian follicle stimulation by the anterior pituitary if shes pregnant!) -stimulates uterine growth -vasodilation -proliferation of breast grandular tissue -relaxes pelvic ligaments and joints -cause of many discomforts and pain the woman feels

amniocentesis

-performed after 14th week gestation -specimen: amniotic fluid collected with a needle from the uterus, creates a kayrotype -tests performed: -alpha-fetoprotein levels (early 2nd trimester) for neural tube defects-- screening test -genetic testing (early 2nd trimester)---diagnosis for spina bifida, or other spinal/ neuro tube defects -test fetal lung maturity (3rd trimester) -L/S ratio -PG presence -Rhogam if rH negative -advantages: accurate diagnosis -risks trauma to fetus or placenta, bleeding, preterm labor, infection

Maternal Gastrointestinal Changes

-physiologic changes: displace of abdominal organs, relaxing of smooth muscle causing vasodilation, decreased gastric tone and motility. -changes in nutritional patterns: increased appetite, cravings, Pica, avoidance of spicy foods, and avoidance of other foods. -discomforts: morning sickness (from hormones), pyrosis (heartburn), constipation, hemorrhoids, cravings, Pica.

Explain the changes in blood volume during pregnancy and how this change can impact lab value, specifically hemoglobin and hematocrit.

-plasma volume increases by 1500 mL-- 40-50%. -An increase in amount of blood can increase blood pressure. -Vasodilation occurs to compensate for blood volume -500 mL increase in RBC. -1000 mL plasma increase. -So, a disproportionate increase causes hemodilution of RBCs. -This causes Hct and Hgb to be lower. -Heart rate increases 10-15 bpm. Which can increase stress on heart. -Increase in CO by 30-50%. -Metabolic rate increases from 10-20% in third trimester. -All put increased risk of complication in HTN and cardiovascular disease or chronic cardiac condition.

characteristics of fragile X syndrome

-prominent or long ears -a long face -delayed speech -large testes (macroorchidism) -hyperactivity -tactile defensiveness -gross motor delays -autistic-like behaviors

List the second and third trimester signs of pregnancy complications that indicate a need to call the doctor.

-same as first trimester -decrease or change in fetal movements -uterine cramping, contraction Sudden weight gain of 2 kg in a week -sudden onset of swelling of face, finger, sacral area -blurred vision, double vision, scotoma Headache: severe frequent, continuous -epigastric or abdominal pain -muscular irritability/convulsions

luteinizing hormone (LH)

-stimulates follicular growth after ovulation -LH surge occurs 24-36 hours before ovulation and stimulates ovulation

Follicular Stimulating Hormone (FSH)

-stimulates the development of ovarian graffian follicles up until ovulation -stimulates the production of estrogen by the developing follicular

human chorionic gonadotropin (hCG)

-sustains pregnancy by stimulating the ovaries to produce estrogen and progesterone -used to preserve the corpus luteum for estrogen and progesterone production to maintain endometrial lining for pregnancy to continue

biophysical assessment

-ultrasound -umbilical artery doppler flow -MRI

follicular phase

-up to 30 graffian follicles (an oocyte and its surrounding cells) enlarges and matures due to the LH and FSH from the anterior pituitary -typically lasts from day 1 to day 14 starting with the first day of menstruation cycle and ends with ovulation. (Lutenizing hormone (LH) surge to select one follicle to go to ovulation) -maturing graffian follicle produces estrogen.

autosomal dominant

1 copy of mutant allele leads to 50 % chance of inheriting trait. Goes through multiple generations. Affects males and females ex: Huntingtons Disease

Three phases of the endometrial cycle

1) menstrual 2) proliferative 3) secretory

three phases of ovarian cycle

1. follicular phase 2. ovulation 3. luteal phase

Fetal Nuchal Translucency

10-14 weeks indication -indicative of trisomies 13, 18, and 21 -fat pad present indicative of trisomy -if positive, blood draw for protein pap A and hcg are decreased then there is an increased likelihood.Further testing : Offer CVS or amniocentesis for diagnosis -only a screen

WBCs may increase to _____ in 2nd and 3rd trimester

16,000. this value does not indicate an infection.

what is a normal BMI for women

18.5-24.9

How many genes do humans have?

20,000-25,000

each cell contains ____ chromosome plus _ sex

22, 1 sex (1 XX female, 1 XY Male)

when does prolactin begin being produced

24-26 weeks

the LH surges ____-___ hours before ovulation

24-36

Lungs fully develop at

35 weeks gestation-- adequate surfactant

antenal fetal surveillance

3rd trimester fetal wellbeing

humes have ____ chromosomes. there are ____ pairs, one being ____ chromosome

46, 23, sex

Hyper coagulable state of pregnancy

50% increase in fibrinogen. Decrease in coagulation inhibiting factors 7, 8, 9 and 10 due to survival of pregnancy based on establishment of vascular connection through the placenta. End result is a decreased chance of bleeding, but increased risk of thrombosis (DVTs)

placenta develops after day ____ of implantation

6

Heart is fully formed by _____ weeks of embryonic development

8

fetus

9 weeks to birth

x-linked

A gene carried on the X chromosome. If a male inherits an X-linked recessive trait from his mother, he expresses that trait because the Y from his father has no counteracting gene. Females are more likely to be carriers of X-linked traits but are less likely to express them.

amniocentesis

A technique of prenatal diagnosis in which amniotic fluid, obtained by aspiration from a needle inserted into the uterus, is analyzed to detect certain genetic and congenital defects in the fetus.

quad marker screening combines four chemical marker (proteins) to detect trisomies and NTD. They include

AFP, hCG, inhibin A, and estriol levels

ultrasonography can be used to obtain all of the following information except: a) placental abnormalities b) fetal trisomies such as downs syndrome c) amount of amniotic fluid d) gestational age

B. Downs syndrome is done through blood, amniotic fluid, or tissue samples

each prenatal visit includes

BP, FHT, Urine check, weight, fundal height (begin at 16 weeks), S&S of pregnancy complications. Pregnancy test, CBC (repeat 28-32 weeks) ABO RH, Indirect Coombs, Rubella, HIV, Hepatitis B, RPR, GC Chlamydia , GBS (35-37 weeks), Glucose tolerance testing , Hemoglobin A1C (preexisting diabetic) Pre- eclampsia labs. Genetic Studies- diagnostic, sample of blood, fluid ,tissue,saliva,or skin cells for Karyotype of chromosomes.

ovulatory phase

Begins when estrogen levels peak and ends with the release of the oocyte (egg) from the mature graafian follicle. LH peaks at 12-36 hours before ovulation, estrogen decreases and progesterone increases.

Multifactorial Birth Defects

Birth defects can be from genetic disorder or teratogen exposure or multi factorial. Usually isolated, not in a syndrome. Abdominal Wall defect, Open Neural Tube Defect, Cleft Lip /Palate, Club Feet, Spina Bifida (surgery in 2nd trimester can repair this). -we see Elevated AFP -some can be prevented by increased doses of folic acid

examples of recessive genetic disorders

CF, sickle cell anemia, thalassemia, Tay-Sachs

NAS symptoms

CNS: irritability, restless, high-pitched cry, incessant crying, tremors, hyper-reflexia, hyperactivity, altered sleep patterns, and seizures. GI: V, D, excessive sucking, poor feeding. Resp: tachypnea, stuffy nose, cyanosis, flaring, retractions, and apnea. Autonomic NS: yawning, sneezing, mottled skin, and fever. Skin: excoriations.

Spinnbarkeit

Clear, slippery, stretchy quality of cervical mucus during ovulation.

When is a developing human most vulnerable to the effects of teratogens?

During organogenesis, which occurs during the first eight weeks gestation.

Exposure to teratogens after 13 weeks gestation may cause what?

Fetal growth restriction or reduction of organ size

spermatogenesis

Formation of sperm, regulated by 3 hormones > follicle stimulating hormone, luteinizing hormone, and testosterone

Assisted Fertility techniques

In vitro fertilization (IVF)- the procedure to harvest oocytes that will be fertilized outside the body Zygote intrafallopian transfer (ZIFT)- fertilized ovum or zygote is placed into the fallopian tubes through laparoscopic procedure and requires an incision Gamete intrafallopian transfer (GIFT)- sperm and ovum placed in fallopian tubes through laparoscopic procedure and requires and incision surrogacy- another woman carries the fertilized ovum egg and sperm donation

noninvasive prenatal diagnosis

Isolate and examine fetal cells circulating in the mother's bloodstream.

Tests for fetal lung maturity

L/S Ratio (Lecithin/Sphingomyelin ratio) -These are 2 components of surfactant -Surfactant lowers the surface tension of the alveoli when the baby exhales ->2:1 ration=fetal lung maturity and decreased risk of RDS PG (Phosphatidylglycerol): -Appears in amniotic fluid at 35 wks gestation -Indicates fetal lungs are mature. LBC- Lamellar Body Count >50,000 indicate fetal lung maturity

effect of smoking during pregnancy

LBW, IUGR, stillbirth, and preterm birth. Neonatal: irritability, tremors, stress dysregulation, increased muscle tone. Increase risk of SIDS and asthma. Goal: prepregnancy and prenatal counseling to stop or decrease smoking

X-linked (sex-linked)

Males primarily affected. Passed by females. No father son transmission. ex: Hemophilia

decidua basalis

Maternal component of the placenta where gas, nutrient and waste exchange occurs. blood does not mix between mother and child

fragile X syndrome

Most common hereditary cause of intellectual disability and autism, Inherited X linked (mostly boys), 1 in 225 women carrier of premutation.

Rhogam is given when?

Mothers who are Rh - receive this at 28 weeks. post delivery if the babies are Rh+ the mother will receive another Rhogam injection

Female factors of infertility

Ovulatory dysfunction- hormonal Tubal or pelvic pathology- constrictures in the filopian tubes, missing ovary Cervical factors- incompetent cervix- weak, opens up early in pregnancy

umbilical artery doppler flow

Procedure - Ultrasound used to evaluate resistance to blood flow in the umbilical cord and the placenta Interpretation- placental perfusion (diastolic resting blood flow of returning blood to the placenta. if absent or decreased then absent end diastolic flow and that the placenta is inadequate.) Advantages- used for infants with IUGR weekly to ensure placenta efficiency.

maternal assays

Screen for birth defects or genetic abnormalities

What are some things that pregnant women should avoid that may contain teratogens?

Should avoid cat feces in a litter box, eating rare beef or lamb, cold cuts

placental maturity for Grade lll: Large indentations and calcifications are prevalent with

Smoking Postterm Preeclampsia Diabetes

Goodell sign

Softening of the cervix, a probable sign of pregnancy, this will become very firm as the pregnancy progresses. -present during first trimester of pregnancy

Pharmacogenetics

Study how one's genetic make-up influences response to particular medications. Improvement of treatment effectiveness and minimizing treatment adverse reactions Targeted therapies personalizes treatment ie: Kalydeco(Ivacaftor) targets the underlying cause, the protein defect that causes Cystic Fibrosis. Improves lung functions, fewer respiratory symptoms, decreased incidence of pulmonary exacerbations, improved weight gain.

relaxin

The hormone that increases the flexibility of the pubic symphysis to accommodate size of fetus during pregnancy

daily fetal movement counts

The presence of fetal movement(FM) is a sign of fetal well-being Start DFMC around 28 weeks gestation ->3 FM/1 hour reassuring -<3 FM/1 hour need for further evaluation -(NST, CST, BPP)

ovulation

The process of releasing a mature ovum into the fallopian tube each month. the empty follicle then becomes the corpus lutium

teratogen

These are drugs, viruses, infections, or other exposures that have the potential to cause embryonic/fetal developmental abnormality

Polyhydramnios

Too much amniotic fluid (normal = 1000mL) diagnosed by >1000mL Associated with fetal anomalies (ability to swallow, heart defects), Rh sensitization, and DM

List the TORCH infections and the possible effects on the pregnancy and fetus

Toxoplasmosis- pathogen in cat litter and uncooked meats. Other (Hep B)- can affect liver function and long term liver problems if the newborn gets it. Interventions: Hbig and Hep B vaccine Rubella, Cytomegalovirus (CMV), and Herpes infections, are some of the most common infections associated with congenital anomalies.

autosomal recessive

Two copies of mutant gene one from mother and one from father to get condition. Can be carriers. 25%have condition 25 % pass on condition 50 % pass trait. Affected individuals in one generation. Affects males and females. Parents may be consanguineous. ex: Cystic Fibrosis or sickle cell

Nuchal translucency screening

Ultrasound screening to measure fetal nuchal folds to assess for potential Down syndrome.

maternal serum analysis

VDRL and RPR test on maternal blood Rubella titer Hepatitis B HIV TORCH NIPS Quad screen

Outline the recommended weight gain based on trimester of pregnancy for a woman with a normal pre-pregnancy BMI

Women with a normal BMI (18.5-24.9) gain 25-35 pounds. First trimester: approx. 5 pounds. Second trimester and third trimester: 1 lb per week

Duchenne Muscular Dystrophy (DMD)

X-linked recessive pattern

Neonatal Abstinence Syndrome (NAS)

a group of conditions caused when a baby withdraws from certain drugs he's exposed to in the womb before birth. Most often caused when a woman takes opioids during pregnancy.

amniotic fluid index (AFI) is

a screening tool that measures the volume of amniotic fluid with ultrasound to assess fetal well being and placental function

doula

a woman, typically without formal obstetric training, who is employed to provide guidance and support to a pregnant woman during labor.

List presumptive signs of pregnancy

amenorrhea, nausea w/ or w/o emesis, fatigue, poor sleep, back pain, constipation, food cravings and aversions, mood swings, heartburn, nasal congestion, sob, lightheadedness, elevated basal body temperature, spider veins, and reddening of the palms

Diagnostic Tests

amniocentesis, ultrasound (considered screening and diagnostic), chorionic villi sampling, and pubs

maternal urine analysis

analysis to test for protein and glucose

When during pregnancy is a woman screened for intimate partner violence?

at the first prenatal visit, at least once per trimester, and at the postpartum checkups Pg 81 and 603. Screened at every prenatal visit. Upon delivery on L and D , and postpartum visit

chromosome

carry genes

maternal changes in the immune system

change in immune system to be able to carry pregnancy to term -change in exposure to pathogens through Specific concern for STI: chlamydia, gonorrhea, Group B strep— if positive at 35 weeks treat with two doses of antibiotics. Most common causes of respiratory infections and sepsis.. , Human Papilomavirus, etc HIV can be transmitted by placental transmission. <2% transmission if mother is treated!!! Zidovudine treatments pregnancy and to the baby after. When in labor, if she has low viral load. We do not do AROM, use forceps, or vacuum, or scalp electrode. High viral road may cause a cesarean delivery. Do not breastfeed. Additional infections that are significant to pregnant woman are listeriosis (uncooked meats or Bri cheese, and cold cuts. Women who are pregnant are at increased risk) Read page 117-121*** cultural precriptions, restrictions, and taboos

chadswick's sign

change in the color of the cervix. blueish/violet blue color due to the increase in vascularity of the cervix. -present during the first trimester of pregnancy

biochemical assessment

chorionic villi. sample of tissue

numerical chromosome problems occur

conception during meiosis Sporadic non disjunction of cells that are aged Risk increases with maternal age Increased risk in numerical chromosome problems Trisomy 13 18 21

menstrual phase

day 1-6 -shedding of the functional 2/3 of endometrium -endometrium in resting state -cervical mucous scanty

proliferative phase

day 6-14 -time of ovulation marks the end of this phase and the beginning of the secretory phase (ovulation) -period of rapid endometrial growth (under the direction of pregesterone) -at ovulation: cervical mucous thin, clear, and stretchy.

Screening tests

designed to identify those who are not affected by a disease or an abnormality -Offered to all pregnant women -Offered to high risk

heterozygous

different alleles/ Homozygous identical alleles

direct transmission

during delivery contact with maternal blood, as ascending in through birch canal

when do pregnancy tests need to be taken

during the first void in the morning.

corpus luteum

empty follicl which produces hormones, estrogen, and progesterone which prepares the uterine lining for receiving an embryo

when you hear progesterone, you should think

endometrium or lining of the uterus

uterine growth in the first trimester is due to

enlargement of the myometrial lining

non stress test

evaluate fetal well being by watching the FHT/FHR reaction to fetal movement using the fetal monitor Procedure : External Fetal Monitor is applied FHT/FHR and contractions recorded for a 20 minute period : Mother presses button with any fetal movement : VAS Vibroacoustic stimulator can be used * FHR/FHT accelerations are expected with fetal movements as a sign of well being : Advantages: outpatient, noninvasive, no contraindications : Disadvantages: must do after 28 weeks. not entirely accurate between 28-32 weeks. :indications for use- -High risk pregnancy complications -Postdates -Decreased fetal movement -Trauma -Placenta abnormalities

sperm antibodies

female cervical mucous that has an immunological reaction against the sperm that causes a decrease in sperm motility intervention: bypass cervical mucous with the sperm.

hCG is produced by

fertilized ovum

List positive signs of pregnancy

fetal heartbeat by doppler or ultrasound, positive hCG urine or blood, hCG. Visualizing fetus during an ultrasound - 10 weeks or a little after can accurately date that pregnancy. Fetal movement when the practitioner does a bimanual exam at 20 weeks gestation

uterine growth in the second and third trimester is due to

fetus

fertilization

fusion of male and female gametes to form a zygote.

Downs syndrome is a

genetic condition which has to do with an extra 21 chromosome not hereditary or inherited from family -soft signs on ultrasound between 18-20 weeks

down syndrome

genetic, trisomy

genetic vs hereditary

genetic: -Having to do with genes and /or chromosomes -Related to gene abnormality -Anything about the genetic make up -Cancer is a genetic disease not necessarily passed on from parents -Organism's genome may be affected by environment, lifestyles, teratogens, or chance -may not be hereditary hereditary: -Able to be passed from parent to child -Defective gene or mutation passed through family -A genetic disorder made up of a gene mutation may not be hereditary

neurohormonal cycle

has a direct impact of whats going on in the ovary. the hypothalamus releases GnRH which stimulates the anterior pituitary gland to release FSH and LH.

what do we test for to confirm pregnancy in the urine and blood samples

hcg

Diagnostic tests

help to identify a disease or provide information to make a diagnosis -Mostly offered to high risk pregnancies -Performed after an abnormal screen pg. 133

male infertility treatment

hormonal therapy lifestyle changes (hot scrotum) corticosteroids antibiotics surgery

embryonic stage of development

implantation- wk 8 -organogenesis -primary germ layers develop at 14 days -ectoderm -mesoderm -endoderm

Maternal renal system changes

increase renal plasma flow and GFR in first trimester then slowly decreases. Increased renal tubular reabsorption. Kidneys cannot reabsorb all glucose filtered by glomeruli this glucose can spill into urine—- result: glycosuria of +1 can be normal in pregnancy. (we do not want to find any protein in the urine as it can indicate hypertensive disorder. ) Left lateral recumbent position maximized cardiac output, renal plasma volume, and urine output.

probable signs of pregnancy

increased frequency of urinations, soft cervix, abdominal bloating/enlargement, mild uterine cramping/ discomfort without bleeding, increased skin pigmentation in the face, stomach, and/or areola. -goodell sign, chadswick, Hegar's sign -breast enlarged/ increased tingling sensation can occur. Skin pigmentation of nipple and areola darkens. Be fitted with a well fitting bra to avoid Back ache and discomfort. Uterus- growth during every trimester.

Maternal Respiratory Changes

increased oxygen consumption by 15-20%. Anatomical changes- diaphragm displaced. Increased chest circumference (due to hormone relaxin that relaxes ligaments in ribcage). Shift from abdominal to thoracic breathing due to fundus pressure. discomforts: shortness of breath, dyspnea (60% of all woman). Interventions include good posture, pillows

Karyotype

is a picture of the total number of an individual's chromosomes including abnormalities

high risk pregnancy

is one in which there is a risk for maternal or neonatal morbidity and mortality

Allele

is one member of a pair that produce variations in traits (hair color, blood type)

what occurs or happens to the endometrial lining around day 25 if a woman does not become pregnant

it sloughs off and she gets her menses

effect of alcohol use on pregnancy

leading preventable cause of birth :FAS abnormalities in three domains: 1) abnormal facies, limb anomalies 2) poor growth 3) cognitive deficiencies :Alcohol related neuro-developmental disorders (ARND) intellectual and behavioral issues that can be seen in isolation :Alcohol related birth defect (ARBD) includes anatomic or phenotypic congenital anomalies that can develop: defects in heart, kidneys, bones, ears, and eyes

female infertility treatments

lifestyle changes-(high BMI) medications- antibiotics for sti -if anovulatory-clomiphene citrate, Pergonal, GnRH - surgery: tubal or myomectomy (remove fibroids)

oligohydramnios

low amount of amniotic fluid. less than 500 mL. can be because the fetus is not peeing out fluid. look for renal anomalies

Outline the interprofessional management plan for women with substance use during pregnancy--- Non pharmacologic intervention:

low noise level, sensitive handling, clusterative care, swaddling, music therapy, infant massage, breastfeeding, non-nutritive sucking (pacifiers), kangaroo care, low lighting, meticulous skin care.

hegar's sign

lower segment of the uterus is soft. When present the uterus can be palpated and pushed on the bladder. A woman in the first trimester can report urinary urgency. Present between 6-12 weeks gestation. Once gone away, no more urinary urgency. -present during the first trimester of pregnancy

function of progesterone during pregnancy

maintains the endometrium, decreases contractility of uterus (which is a smooth muscle), and stimulates maternal metabolism

effect of marijuana on pregnancy

maternal effect: tachycardia and decreased B/P :effect on pregnancy: premature rupture of membranes (PROM), preterm labor (PTL), placenta previa and abruption, poor weight gain : neonate can present with neonatal abstinence syndrome (NAS) and increased risk of SIDS

human chorionic somatotropin (hCS or hPL) stimulates _____________ . it also ___________,__________________, and _________________

maternal metabolism so there is a sufficient supply of nutrients available to the fetus. it also increases insulin resistance, facilitates glucose transport across placental membrane, and stimulates breast development

Discomforts r/t cardiovascular changes

nasal stiffness and epistaxis. Palpitations: unknown cause. Not preventable but needs to be evaluated to ensure it is benign.

Advanced maternal age increased risk in

numerical chromosome problems -syndrome

Organogenesis

organ formation that takes place during the first two months of prenatal development

LH is responsible for

ovulation

Ultrasound

page 134-137 Procedure -High frequency sound waves are used to produce images of organs or tissue Baby gestational age, growth, anatomy, abnormalities, activities, position -Serial Ultrasound to watch growth (IUGR) -Amniotic fluid amount and studies -Placenta and cord -Cervical length -Used with other procedures Indications- *screen or diagnostic* --varies with trimester (1st- confirm, 2nd anatomy and growth, 3rd amniotic fluid) abdominal or vaginal Interpretation and advantage Risks-None nursing actions: need full bladder for first half of pregnancy. second half, empty bladder

hereditary

passed through the genes

Diagnosis of infertility

physical exams (both man and woman at the same time screening for STIs (both woman and man) basal body temp (woman)- checking cervical mucous. women knowing when to ovulate. unilateral pain— middleshmirtz Assessment of hormonal levels: male and female **know what to test for* Semen analysis: Know pre-testing instructions Assessing for ovulatory dysfunction: How is this assessed? Hysterosalpingogram: put dye in the female reproductive test to ensure everything is patent Endometrial biopsy: Define how test is performed and what is being tested. to see if endometrial lining is think and healthy enough laparoscopy- look at the outside of the female reproductive tract to find uterine fibroids in myometrium. fibroids can grow and impede causing pain and increased risk of preterm l and d to interfere with growth of the uterus.

3 major causes of maternal demise

pp hemorrhage PE hypertensive disorder

effects of heroin on pregnancy

preterm birth, IUGR, stillbirths; pre-eclampsia. Newborn presents with NAS. Treatment: methadone/ buprenorphine: will still withdrawal but better than heroine.

function of progesterone during monthly cycle

progesterone causes the build up of the endometrium, and stimulates breast development

Maternal Assays

quad/tri screen, look for abnormal chromosomal conditions

gene

sequence of DNA that codes for a protein and thus determines a trait

If mother is Rh-

she would need a rhogam injection

Hegar's sign

softening and compressibility of lower uterus. can cause uterus to antiflex onto bladder

if there is an increase amount of fluid in the neck

strong indication for a trisomy.

Fundal height is measured from

superior aspect of the symphysis pubis to the fundus

embryo

the developing human organism from about 2 weeks after fertilization through to 9 weeks

Zygote

the fertilized egg; it enters a 2-week period of rapid cell division and develops into an embryo

Genotype (genome) expressed in

the genetic constitution of an individual organism.

oogenesis

the production, growth, and maturation of an egg, or ovum

nondirective counseling

the type of counseling that assumes the client is the one who knows what is best and should not be in a passive role. This results in the therapist permitting the client to lead the counseling instead of the therapist doing the leading.

biophysical profile (BPP)

to evaluate fetal well being using NST and US Procedure: Electronic Fetal Monitor ( NST) :Ultrasound looks at fetal breathing movements, gross body movements, fetal tone, and Amniotic fluid volume (AFI) (2 cm single vertical pocket). **** Each of the above carry a score of 2 points. Score interpretation : Normal 8-10 (fetal wellbeing) :Equivocal 6 (need to repeat) :Abnormal <4 (deliver fetus asap...emergency cesarean section)

Phenotype

traits that you see. Phenotype may be affected by environment

Perinatal transmission

transmission of a disease-causing agent (a pathogen) from mother to baby during the perinatal period, the period immediately before and after birth. Also called vertical transmission. "transplacentally and during breastfeeding"

Outline the interprofessional management plan for women with substance use during pregnancy. pharmacologic intervention:

treat complication/ symptoms, test for infections, urine drug screening and meconium. Analysis, social service referral, pharmacologic management for opiate withdrawal: first line: oral methadone or buprenorphine Primary prevention: reduce prevalence of illicit substance use among adolescents and women of childbearing age :best if interventions are started preconceptually :prevent unintended pregnancies in an at-risk population :screen all women at prenatal visits :implement comprehensive plan of care- opioid assisted treat w first line opioid replacement therapy methadone, prenatal care, prenatal parenting education

Iron deficiency or pathologic anemia treatment and concerning HcT and Hgb

treat her for iron but that can be constipating so only do this if anemic. Treat if HCT lower than 33- 37. Hb- 11-16. Can increase risk of PP hemorrhage. Platelets no significant change but low platelet levels can impact the ability to have an epidural.

Mittleschmerz

unilateral abdominal pain associated with ovulation

maternal bladder changes during pregnancy

urine output increases by 60-80%. Pressure on right ureter—- UTI risk. Pressure on urethra —- risk of bladder infection. discomforts: urinary urgency and frequency 3rd trimester. Can also present in first trimester as result of Hegar's sign. interventions: do not try to decrease amount she drinks. Dehydration can cause preterm labor.

fetal stages of development

weeks 9-birth. 20 weeks: 19 cm and 450 grams 24 weeks: 23 cm and 820 grams alveoli formed and begin producing surfactant (35 weeks adequate surfactant). (born now can experience respiratory distress syndrome from lack of surfactant production) 32 weeks: 30 cm and 2100 grams 36 weeks: 34 cm and 2900 grams 40 weeks: 36 cm and 3400 grams -table 3-4 p 49

zygote

zygote (46 chromosomes) -day 3-16 cell morula -dy 5- Blastocyte- embryoblast and trophoblast -mutiple gestation -dizygotic -monzygotic

Administration of Pitocin to augment/induce labor or to stimulate contractions for a CST

➢ Pitocin is always administered using an IV pump. ➢ It is set up as a secondary infusion and is piggybacked into a mainline. ➢ Pitocin piggybacked into the mainline at a port closest to the IV insertion site -Pitocin Infusion rate begins at 1 mu/min and titrate a 1 mu/min every 30 min until 3 contractions in 10 min. (No more or no less) -Observe Vital signs, contractions, and FHR. -Observe for fetal distress or tachysystole