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OB-Antepartum
| Question | Answer |
|---|---|
| stage of fetal development: brain differentiates, limb buds grow, and the stomach, pancreas and liver begin to form | week 4 |
| stage of fetal development: heart developed, facial features continue to develop, and resembles a human | week 8 |
| stage of fetal development: gender forms by __ to __ week, urine begins to be produced and excreted, head/face formed, limbs are long and digits well formed | weeks 9-12 |
| stage of fetal development: rapid brain growth, fetal heart tones heard with Doppler, vernix caseosa covers the fetus, muscles well developed and eyebrows with head hair and nails are present | weeks 17-20 |
| stage of fetal development: fetus has hand grasp & startle reflex, alveoli forming in lungs, lungs begin to produce surfactant, body is lean & skin translucent | weeks 21-24 |
| stage of fetal development: fetus reaches 15 inches, rapid brain growth, nervous system controls some functions, blood formation shifts from spleen to bone marrow | weeks 25-28 |
| stage of fetal development: rapid increase in body fat, rhythmic breathing movements occur and lungs still developing | weeks 29-32 |
| stage of fetal development: fetus fills uterus and increase in body fat, lanugo begins to disappear, testes are in scrotum of male, small breast buds appear and antibodies are supplied to fetus | weeks 33-38 |
| **amenorrhea, N/V, breast sensitivity, fatigue, urinary frequency, sickness in morning; least reliable signs of pregnancy as they may be caused by other conditions | **presumptive signs (changes felt by woman) |
| **uterine enlargement, positive urinary pregnancy tests, Hagar’s sign, Chadwick’s sign, Goodell's sign | **probable signs (changes observed by examiner) |
| **fetal heartbeat (8-12 wk.’s by doppler/ 18-20 wk.’s by auscultation), palpation of fetal movement, and visualization of fetus by ultrasound | **positive signs (definite signs of pregnancy) |
| Tx includes: avoid odors, eat dry crackers or toast before arising, small frequent meals, avoid greasy/spicy foods, drink fluids between meals | treatment for N/V |
| What causes N/V in pregnancy? | high levels of HCG, fatigue, changes in carbohydrate metabolism |
| Tx: sit up after meals, avoid greasy/fried food, eat small frequent meals, antacids (Tums) | heartburn (from increased progesterone) |
| Tx: wear well-fitted, supportive bra | breast tenderness (from increase of estrogen/progesterone) |
| Tx: take naps, reduce work hours | fatigue (from metabolic demands for fetus growing, tiring schedule, or interrupted sleep) |
| Tx: cool air vaporizer, normal saline drops/spray | nasal stuffiness (from high estrogen levels) |
| Tx: void as urge is felt, increase fluid in day and reduce in evening, Kegel exercises | urinary frequency (from pressure of uterus on bladder) |
| risks for ____? urinary stasis from pressure of growing uterus on bladder, renal changes, vaginal flora become more alkaline | risks for UTIs |
| risks for this can be decreased by: wiping front to back, avoiding bubble baths, wear cotton underwear, avoid tight-fitting pants, consume plenty of water, urinate before and after sex | UTIs |
| Tx: drink plenty of fluids, eat a diet high in fiber, exercise regularly | constipation-increased levels of progesterone, pressure of enlarged uterus on intestine, diet, lack of exercise |
| Tx: warm sitz bath, witch hazel pads, apply topical ointments that help relieve discomfort | hemorrhoids (from increased pressure on veins and constipation) |
| Tx: exercise regularly, perform pelvic tilt exercises, use proper body mechanics when lifting, side-lying position | backaches (from increased curvature of spine, fatigue, poor body mechanics & softening of cartilage in body joints) |
| Tx: maintain good posture, sleep with extra pillows, contact provider if Sx worsen | shortness of breath/dyspnea (from decreased vital capacity from pressure of enlarging uterus on the diaphragm) |
| Tx: stretching affecting limb (dorsiflexion), heat on affected muscle or foot massage | leg cramps (from imbalance of calcium/phosphorus ratio, increased pressure of uterus on nerves, fatigue, poor circulation to low extremities) |
| Tx: rest with legs elevated, avoid constricting clothing, wear TED hose, avoid sitting or standing for extended periods, don't cross legs when sitting, sleep in left-lateral position, exercise | varicose veins and lower-extremity edema |
| change of position and walking should cause this to stop | Braxton Hicks contractions |
| increased vascularization causes softening of the cervix | Goodell’s sign |
| a bluish purple discoloration of the cervix (ovaries cease ovum production during pregnancy; vagina hypertrophies, increases secretion and relaxes for a passageway at birth) | Chadwick’s sign |
| softening of the isthmus of the uterus (6-8 wks) | Hagar’s sign |
| ease in flexing the body of the uterus against the cervix | McDonald’s sign |
| passive fetal movement elicited by pushing up against the cervix with 2 fingers | Ballottement |
| key hormones in pregnancy | hCG, hPL, Progesterone, Estrogen, Relaxin & Oxytocin (Pituitary Gland) |
| Naegele’s rule | count back 3 mo.’s from 1st day LMP and add 7 days and 1 yr. |
| Fundal height levels; performed to assess the fetal gestational age, check for fetal growth retardation or multiple fetuses | above level of symphysis (12-14 weeks); at umbilicus or 20cm (20 weeks) rises about 1cm/wk. until 36 weeks |
| maternal weight gain in pregnancy | 24-28 lbs (1st trimester: 2-4 lbs, 2nd: 12-14 lbs, 3rd: 8-12 lbs) |
| fetal heart rate (FHR) | 120-160 beats/min |
| total number of pregnancies | gravida |
| number of past pregnancies that have made it beyond the period of viability (after 20 weeks) or born dead or alive | para |
| fetal movement occurs about 18-20 weeks gestation | quickening |
| purplish stretch marks that turn silver can develop | striae |
| dark line up middle of abdomen | linea nigra |
| blood volume: increases by ___% and peaks at ___ weeks | 30%, 28 weeks |
| Maternal cardiac change: Common for a _____ ______ to occur d/t increased cardiac volume. The pulse may increase by ___ beats. | systolic murmur; 10 |
| reduces blood flow returning to the heart and may cause maternal hypotension if lying supine | vena cava syndrome |
| Tx: daily cleansing, cotton underwear, avoid douching | increased vaginal discharge (from high estrogen levels cause endocervical glands to secrete mucus) |
| Tx: low stress environment & emotional support | psychological changes (mood swings, introverted, or ambivalence) |
| non-invasive test using high frequency sound waves and external signal source for fetal surveillance | ultrasound |
| reasons for ultrasound | confirm pregnancy/fetal viability, check for ectopic pregnancy, determine fetal structures, anatomy, fetal position, placental position, detect anomalies, figure out gestational age, and multiple births |
| **detects neural tube defects and Down syndrome; done 15-18 weeks gestation or second trimester; if elevated then an amniocentesis test is performed | **maternal serum alpha-fetoprotein (AFP) |
| cervix to anal swab test, if (+) treat with antibiotics to avoid sepsis in newborn; done 35-37 weeks gestation | group beta strep (GBS) |
| invasive test: needle into abdomen/uterine walls; 16 weeks gestation to detect genetic disorder; >30 weeks gestation to assess L/S ratio or check lung maturity | amniocentesis |
| **complications of ____: absent fetal heart rate or movement, premature labor, infection, abruptio placenta, or an amniotic embolism | **amniocentesis |
| **continuous vomiting in first trimester that depletes fluid and electrolytes; > or = to 5% weight loss during pregnancy due to excessive vomiting.; Sx: dehydration and electrolyte imbalances | **hyperemesis gravidarum |
| an infection contracted that could cause fetal defects, i.e. raw meat or cat feces | toxoplasmosis |
| German measles that may cause infection or defects in the fetus | rubella |
| area where fertilization takes place | fallopian tube |
| these support the upper portion of the uterus and help keep the uterus centrally placed | round and broad ligaments |
| a hormone that appears in the bloodstream soon after implantation | HCG |
| hormone that maintains the endometrial lining during pregnancy | progesterone |
| promotes enlargement of the genitals, uterus and breasts | estrogen |
| hormone that increases flexibility of the pubic symphysis to allow pelvis to expand during delivery | relaxin |
| **evaluate fetal response or fetal heart rate to natural contractile uterine activity, or to increase in fetal activity; reactive response is 2 or more accelerations of FHR lasting >15sec. associated with fetal movement in a 20min. period | **non-stress test (NST) |
| test to stimulate uterine contractions for the purpose of assessing fetal response (healthy fetus does not react to contractions); tested with IV pitocin or nipple stimulation and external monitoring | contraction stress test (CST) |
| **measures fetal breathing movement, gross body movement, fetal tone, FHR, and amniotic fluid; non-invasive: uses ultrasound and fetal monitoring; reasons: management of pregnancies at risk d/t HTN, IUGR, DM, multiple fetuses, or preterm labor | **biophysical profile (BPP) |
| test for gestational diabetes (diagnosis requires two elevated readings) | glucose tolerance test (GTT) |
| **many women diagnosed with preeclampsia beforehand; usually develops before the 37th week of pregnancy but can occur shortly after delivery; Sx: nausea, headache, abd pain, swelling in extremities, high B/P, malaise, headache | **HELLP syndrome |
| **HELLP syndrome: what does it stand for? | **hemolysis (resulting in anemia and jaundice), elevated liver enzymes (elevated ALT/AST, epigastric pain, N/V), low platelet levels (thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possibly DIC) |
| meds for HELLP syndrome | IVFs, vasodilators, antihypertensives, beta blockers, IV mag (keep calcium gluconate at bedside if mg toxicity occurs) |
| **Tx: IV hydration and electrolyte replacement, monitor I/O and labs, quiet environment, rest, stress reduction, avoid noxious odors, antiemetics | **hyperemesis gravidarum |
| cervix is unable to remain closed until pregnancy reaches term; Tx: cerclage, bedrest, hydration, tocolysis, and hospital fetal monitoring; reasons: recurring losses, short cervix, or several vaginal deliveries | incompetent cervix |
| **implantation of the fertilized ovum outside of its normal place in the uterus (i.e. ovary, fallopian tube, or abdominal cavity); Tx: methotrexate in early pregnancy, salpingostomy or laparotomy (abdominal in late pregnancy), D&C | **ectopic pregnancy |
| no fetus; a gestational trophoblastic disease; risk with fertility drugs, nutritional factors and history of miscarriages; Sx: anemia, N/V, abd cramps | Hydratidiform mole |
| Tx: induce labor or suction curettage, U/S, BHCG titers monthly for up to 1yr., genetic counseling, referral to support resources, and chemotherapy for persistent disease | Hydratidiform mole |
| **BP>140/90 x2, 4-6hr apart in a week, proteinuria>1+,transient H/A’s, irritable, placental perfusion normal | **mild preeclampsia |
| **BP>160/110 x2, proteinuria >3+, hyperreflexia with possible ankle clonus, pedal/ankle edema 1-4+ pitting or non-pitting, HAs, blurred vision, severe irritability, HELLP syndrome, or decreased placental perfusion | **severe preeclampsia |
| **Tx: IV Mg; antihypertensive meds, check weight, strict I/O, IVs/electrolytes, VS, check maternal reflexes (and check if clonus is present), bedrest on left side or activity restrictions, DVT prevention strategies | **preeclamsia |
| **early signs: nausea, flushing, muscle weakness, decreased reflexes, slurred speech; late signs: loss consciousness, respiratory/cardiac depression, loss of reflexes, and oliguria | **Mg toxicity |
| **severe preeclampsia manifestations w/onset of seizure activity or coma; usually preceded by HA, severe epigastric pain, hyperreflexia, and hemoconcentrations | **eclampsia |
| **any degree of glucose intolerance with the onset or first recognition occurring during pregnancy; Tx: insulin | **gestational diabetes |
| **premature separation of placenta from uterus; Sx: uterus “boardlike” on palpation, severe abd pain, possible contractions, dark red bleeding and non-reassuring FHR pattern; risks: abd trauma (i.e. MVA, maternal battering, cocaine use, or maternal HTN) | **abruptio placenta |
| **Tx: emergent C-section, monitor fetal/maternal status, exam & US | **abruptio placenta |
| **placenta abnormally attaches to lower segment of uterus near or over cervical os instead of attaching to fundus; Sx: no uterine tenderness, painless vaginal bleeding (bright red color), normal FHR; confirmed with US | **placenta previa |
| **Tx: monitor bleeding, weekly fetal monitoring, pelvic rest, avoid douching, intercourse, enema, cervical or rectal exams, plan for a C-section delivery | **placenta previa |
| **risks: previous C-section, endometrial scarring, multiple gestation, or a prior occurrence | **placenta previa |
| decreased amount of amniotic fluid (less than 500 mL); may result from any condition that prevents the fetus from making urine or blocks it from going into the amniotic sac; puts the fetus at an increased risk of perinatal morbidity and mortality | oligohydramnios |
| too much amniotic fluid (more than 2,000 mL) surrounding fetus; associated with fetal anomalies of development i.e. upper GI obstruction, neural tube defects, and anterior abd wall defects | polyhydramnios |
| retrovirus that attacks and causes destruction of T lymphocytes; causes immunosuppression; transmitted from mother to neonate perinatally through placenta and postnatally through breast milk | HIV |
| risk factors: IV drug use, multiple sex partners, maternal history of STIs, blood transfusion (rare occurrence), homosexual men | HIV |
| Sx: fever, diarrhea and weight loss, lymphadenopathy and rash, anemia | HIV |
| med for HIV | retrovir (antiretroviral agent) |
| **curable STI; many asymptomatic but can still infect others through sexual contact; Sx may include: genital pain and discharge from the vagina or penis | **chlamydia |
| STI ; may be asymptomatic; Sx include: painful urination and abnormal discharge from the penis or vagina, men may experience testicular pain and women may experience pain in the lower belly | gonorrhea |
| Tx: ATBs (such as ceftriaxone, azithromycin, doxycycline); if untreated, may cause infertility | gonorrhea |
| **common STI marked by genital pain and sores; pain, itching, and small sores appear first, they form ulcers and scabs; after initial infection, lies dormant in the body; Sx can recur for years | **genital herpes |
| **meds can be used to manage outbreaks (acyclovir, valacyclovir, famciclovir) | **genital herpes |
| **Tx: ATB for affected pt and pt's sexual partner(s) recommended (i.e. azithromycin, amoxicillin) | **chlamydia |
| **STI that causes warts in various parts of body (depends on strain); many people asymptomatic but can still infect others through sexual contact; Sx may include warts on the genitals or surrounding skin; no cure but warts may go away on their own | **HPV |
| **Tx: focuses on removing the warts; there is a vaccine recommended for teens for prevention of strains most likely to cause genital warts and cervical cancer | **HPV |
| infection most commonly caused by Haemophilus vaginalis or Gardnerella vaginalis; activities that change the balance of bacteria in the vagina, such as sexual intercourse or frequent douching, can increase a person’s risk | bacterial vaginosis (BV) |
| Sx: some asymptomatic, there may be abnormal vaginal discharge, itching, or odor; Tx can include prescription cream, gel, or medication (metronidazole). Recurrence within 3 to 12 months is common, requiring additional treatment | bacterial vaginosis (BV) |
| A yeast infection of the vagina and tissues at the opening of the vagina (vulva); caused by candida albicans; Sx: inflammation, intense itchiness, and a thick, white discharge from the vagina | candidal vulvovaginitis |
| Tx: single dose of an oral antifungal drug (fluconazole) or application of an antifungal cream for one to three days cures mild infections; complicated infections require longer-term treatment | candidal vulvovaginitis |
| a rubber, dome-shaped device that is inserted into the vagina and placed over the cervix; fits into place behind the woman's pubic bone and has a firm but flexible ring that helps it press against the vaginal walls | diaphragm |
| **injected every 3 months at a doctor's office; prevents pregnancy by stopping the woman from releasing an egg; does not protect against STIs | **Depo-Provera (medroxyprogesterone) |
| **small, flexible T-shaped device that is placed in the uterus by a physician; stays in place as long as pregnancy is not desired; depending on the type (hormonal or copper), it will last for 3, 5 or 10 years; causes degeneration of the fertilized egg | **intrauterine device (IUD) |
| **combined med that is taken daily; contains two hormones (estrogen and progestin); the hormones stop the release of the egg, or ovulation; they also make the lining of the uterus thinner | **oral contraceptives |
| form of female sterilization; surgeon will cut, block, or burn the fallopian tubes, or a combination of these methods, to seal them and prevent future fertilization | tubal ligation |
| surgery to make a man sterile; the tubes through which sperm pass into the ejaculate are cut or blocked; is sometimes reversible, but with a higher abundance of abnormal sperm, possibly resulting in lower fertility or birth defects | vasectomy |
| med to delay premature delivery or to slow/reduce contractions | terbutaline sulfate |
| med for eclampsia/seizures during pregnancy | magnesium sulfate |
| med for iron deficiency and anemia | ferrous sulfate |
| med to induce labor; also used for postpartum hemorrhage | misoprostol (Cytotec), oxytocin (Pitocin) |
| med to prevent newborn eye infection | erythromycin ophthalmic ointment |
| med to prevent newborn bleeding | phytonadione (Vitamin K) |
| **fundal measurement | **between 12 and 14 weeks’ gestation, above the symphysis pubis; fundus reaches the level of the umbilicus at approx 20 weeks and measures 20 cm; fundal measurement should approximately equal the number of weeks of gestation until week 36 |
| **Tx: magnesium IV, terbutaline, betamethasone; treat underlying cause | **preterm labor |
| **advantages: highly effective if taken correctly, decreased menstrual blood loss, decreased iron-deficiency anemia, regulation of cycles, reduced incidences of dysmenorrhea and PMS, offers protections against certain cancers, improves acne | **oral contraception |
| **disadvantages: no protection against STIs, increased risk of stroke/ MI/ HTN, exacerbates conditions affected by fluid retention (migraine, epilepsy, heart disease), adverse effects (HA, nausea, breast tenderness) | **oral contraception |
| **advantages: very effective, only four injections per year, does not impair lactation, possible absence of periods and decrease in bleeding, decreased risk of uterine cancer if used long-term | **Depo-Provera (medroxyprogesterone) |
| **disadvantages: adverse effects (decreased bone mineral density, weight gain, increase in depression, irreg. vaginal spotting/bleeding), no protection against STIs, return to fertility can be delayed | **Depo-Provera (medroxyprogesterone) |
| **advantages: effective 1-10 years, can be inserted immediately after abortion/ miscarriage/ childbirth/ while breastfeeding, can be reversed with immediate return to fertility | **intrauterine device (IUD) |
| **disadvantages: can increase risk of PID/ uterine perforation/ ectopic pregnancy, can be expelled, no STI protection | **intrauterine device (IUD) |
| **effective for three years with local insertion in arm/removal; subdermal implant | **implant (Nexplanon) |
| **advantages: effective continuous contraception for 3 years, can be inserted immediately after abortion/ miscarriage/ childbirth/ while breastfeeding, reversible | **implant (Nexplanon) |
| **disadvantages: can cause irreg. menstrual bleeding, no STI protection, local bruising at insertion site | **implant (Nexplanon) |
Created by:
nurse savage
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