exam 2-OB
GTPAL SYSTEM
Nagales Rule
identify first day of LMP
-subtract 3 months and add 7 days
-its the start of the period
physical exam position
lithotomy position
chronic villi sampling
check for genetic disorders (11-13 weeks)
nvchal transluceray testing
11-13 weeks chrome abnormalities
amniocentesis
diagnose Down syndrome
group B streptococcus
screening at 35 to 37 weeks to detect presence of GBS in the birth canal which would infect the newborn
Quadruple screen
checking for Down syndrome
Amnicentesis
usually done before 20 weeks, bladder should be fun to support the weight of the uterus.
-after 20 weeks bladder should be empty to reduce risk of puncturing the placenta or fetus
complications for amniocentesis
spontaneous abortion, leakage of fluid, and infection
subsequent visit care
a urinalysis will be preformed to check for glucose, ketones, protein, and nitrates
fundal height
helps to determine fetal growth/ amniotic fluid level
fetal heart rate
normal is 110-160 BPM
Quickening (the feeling of life inside)
16-22 weeks
important to assess the mom's heart rate at the same time to ensure it is the fetal heart rate being heard
(t/f)
true
lightening
the uterus drops
after delivering, the uterus should drop down to the umbilicus
(t.f)
true
40 weeks is a normal pregnancy
(t/f)
true
to much saline can cause dryness
(t/f)
true
how many minutes of exercise is permitted?
30 minutes
-moderate exercise after being cleared by physician
should you avoid prolonged standing and environmental hazards while being pregnant ?
yes
while driving, how far from the airbag should you keep the abdomen away?
10 inches
-second trimester is the safest to travel
-avoid prolonged sitting; ambulate every 2 hrs
TORCH
used to describe infections that are known to cause congenital defects
TORCH
breast-feeding is contraindicated for what women?
HIV postive
Group B (GBS)
leading cause of perinatal infection with high mortality rate
treatment- penicillin
Rubella (German measles)
most dangerous to developing fetus in first 12 weeks of pregnancy
after rubella vaccine, women should NOT get pregnant for at least 1 month
(T/F)
true
rubella should avoid exposure to young children, especially during the first trimester
(T/F)
true
cytomegalo virus
intimate contact with saliva, urine, and other body fluids
prevention for cytomegalovirus
using good hand washing technique, do not share food, drinks with young children
treatment- NONE
-theraputic abortion may be offered if CME infection is discovered early in pregnancy
herpes simplex virus
one of the most common STI'S
-most dangerous to the fetus during the third trimester
-if we know mom has this, we schedule a c-section
-mother and infant do not need to be isolated as long as direct contact with lesions is avoided
nutriton in preganncy
take a multi vitamin with iron as long as cleared with practitioner
general guidelines
ensure extra caloric needs of 300 cal/day during the last six months
-recommended weight gain during pregnancy 25-35 lbs
are live vaccines contraindicated during pregnancy ?
yess
thimerosal (found in vaccines)
should not be given during pregnancy due to risk of mercury poisoning
Hypercemesis grauidarum
excessive n/v persisting past 20 weeks gestation
-can impact fetal growth
-this is NOT. morning sickess;this Is more severe
-reduced delivery of blood, oxygen, and nutrients to the fetus
-BUN elevates, elevated HR and orthostatic
types of abortions
spontaneous
natural loss of pregnancy (miscarriage)
types of abortions
threatened
S/S of vagina, bleeding, cramping suggests miscarriage but fetus is still alive
types of abortion
inevitible
when miscarriage cannot be prevented
-almost certain to be loss
types of abortion
incomplete
not all pregnancy tissue comes out of uterus, will cause mom to bleed until all tissue is out
types of abortion
complete
when all pregnancy tissue is expelled from uterus. bleeding stops and uterus goes back
types of abortions
missed
pregnancy has just stopped developing. the body doesn't immediately recognize, they will have to go in surgically and remove fetus
bleeding disorder
document amount and charter of bleeding
-save anything that looks like clots or tissue for evaluation by a pathologist
-monitor vital signs
-if actively bleeding, mom should be kept NPO in case surgery is needed
methotrexate
used for arthritis and is used in ectopic pregnancy
-dissolves the growth
-the patient should avoid foods high in folic acid
ectopic pregnancy
very painful
-biggest thing: control bleeding
-may be felt (pain) in tube (notes below)
mittleshmirtz
pain in ovulation
hydatiform
mole or molor pregnancy
-occurs because the chronic villi abnormally increases and develop vesicles
-no baby in the uterus: empty egg with no DNA
cause: just a freak thing that happens
46 choromosomes all from the father
a distinct "snow storm" pattern is an ultrasound with no evidence of a developing fetus
(t/f)
true
methotrexate
a medication used to stop the rapid growth of the mole
placenta previa
the placenta is implanted near the opening of the cervix, the cervix dilates and bleeding occurs (painless bleeding)
mardinal
low line, close to the cervix
partial
partially covering the cervix
complete
placenta is covering the cervix
DIC
Disseminated intravascular coagulation
s/s include petechiae, oozing from injection sites and hematuria
placenta abruptio
premature separation of the placenta from the wall of uterus.
s/s- patient will have dark red bleeding with pain, severe uterine tenderness, firm birdlike abdomen or lower back
-life threatening for mom and fetus
-monitoring bleeding, vital signs, and fetus HR
care of patient with excessive bleeding
place patient on left side
you always monitor from the beginning of one contraction to the beginning of the next
(t/f)
true
if the mom is RH negative and is exposed to RH positive, if the babys positive, maternal blood should be tested when?
at the initial appointment
normal fetal heart rate
110-160
Rohgam
first injection given at 28 weeks, 72 hours after delivering
high blood pressure can cause what?
preeclampsia and eclampsia
-if renal heart tones remain from 120-160, consider this normal
HELLP syndrome
HELLP- S/S
chronic HTN during pregnancy and b/p of 140/90mm hg or greater before pregnancy or that occurs before 20 weeks gestation
what is the normal weight gain during pregnancy
25-35 lbs
-moderate exercise, only if cleared by dr
gestational hypertension
elevated blood pressure
-b/p to return to normal less than 12 weeks postportum
-rest on left side (helps with circulation to the baby)
iron
better absorbed on an empty stomach and better with vitamin C
pre-eclampsia
hypertension and proteinuria after 20 weeks gestation
s/s- categorized as mild or severe
-magnesium sulfate given to induce labor
-first line treatment: hydralazinene and labatalol
HELLP S/S
elevated LDH, AST, ALT, BUN, bilirubin, uric acid level and creatine counts
-women ar risk for this is someone with chronic hypertension, older moms, previously had this syndrome
erythroblastosis fetalis
condition of red blood cells in body
-adminsiter rohgan at 28 weeks or within 72 hours
-inta blood infusion for baby
multiple gestation pregnancy
multiple babies
-rapid weight gain
-extreme breast tenderness
diabetes mellitus
classified by weather it proceeded pregnancy or had its onset during pregnancy
type 1- insulin type 2-diets and medications
In true GDM, glucose usually returns to normal when?
by 6 weeks postpartum
effects of pregnancy on glucose metabolism
hormones (estrogen and progesterone)
the placenta hormones
glucose stays in the bloodstream instead of entering cells
organogenesis
leads to neural tube defects
-women with gestation diabetes during pregnancy have higher risk of getting type 2 later in life
insulin is usually the first choice of medication as it does NOT cross __________
the placental barrier