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Maternity Exam 1
Normal pregnancy
Question | Answer |
---|---|
AMA | advanced maternal age >35 y/o |
trophoblast becomes... | the placenta |
blastocysts become... | the fetus/embryo |
L:S ratio considered mature | 2:1 L and S are surfactants |
IgG is acquired in fetus through... | the placenta |
IgA is acquired in newborn through... | breastfeeding |
presumptive signs of pregnancy | subjective -Breast changes -Amenorrhea (no period) -N&V -Urinary frequency -Fatigue -Quickening |
Probable signs of pregnancy | Goodell's sign→ cervix is soft Chadwick's sign→ vagina and cervix is bluish color d/t increased vascularization Hegar's sign→ softening of lower uterine segment Positive pregnancy test Braxton hicks contractions Ballottement |
positive signs of pregnancy | Visualization of fetus by US(ultrasound) or Xray(do not use xray on pregnant woman) Presence of fetal heart tones Fetal movement palpated by examiner |
hcg | Human chorionic gonadotropin -Biologic marker for pregnancy -will double every 48 hours if not an ectopic pregnancy |
Naegele’s Rule | start with LMP -Subtract 3 months -Add 7 days -Add 1 year |
Fibrinogen levels _______ in pregnancy | increase |
HCT _______ in pregnancy | decreases |
Fundal height = | weeks gestation at 20 weeks fundus should be at umbilicus |
Hegar's sign | Softening and compressibility of lower uterine segment |
chadwick's sign | bluish color of the cervix and vagina d/t increased vascularization |
Goodell's sign | Softening of the cervix occurs by 6-8 weeks |
physiologic anemia | Blood volume increases during pregnancy and causes a decrease in normal hemoglobin (12-16 g/dl) and hematocrit (37%-47%). Results in physiologic anemia --> if less than 11 g/dl or 33% then considered anemia |
Facial chloasma/melasma | darker pigmentation around face→ “mask of pregnancy” |
Linea nigra | pigmented line up abdomen |
Hirsutism | hair growth on upper lip and chin |
Diastasis recti | abdominis muscles separate → may persist after pregnancy→ encourage body mechanics(get up sideways) |
Screening/Assessments Done at Each Prenatal Visit | BP weight fundal height fetal heart tones Abdominal pain Visual changes Reflexes Headache Vomiting Urinary complaints Constipation Vaginal discharge, bleeding, leaking of fluid Fetal movement urine (for protein, glucose, pH, ketones, nitrates |
trimester 1 to do | health history CBC blood type antibody screen Renal Function tests Rubella / Varicella RPR/VDRL HBsAg STI’s and Vaginitis Pap test UA PPD HIV Symptom/Physical assessment date of pregnancy relief to discomfort danger signs pregnancy course |
trimester 2 to do | relief of discomforts danger signs repeat antibody test quad screen |
trimester 3 to do | relief of discomfort danger signs signs of labor/when to come to hospital GBS |
trimester 1 weeks | 1-13 6/7 |
trimester 2 weeks | 14-26 6/7 |
trimester 3 weeks | 27-delivery |
trimester 1 common discomforts | Pain/tingling in breasts N/V(can use ginger to help, small frequent meals throughout day, vitamin B6 mixed with unison helps with morning sickness but is expensive) urinary frequency fatigue mood swings hemorrhoids |
trimester 1 danger signs | Vaginal bleeding abdominal cramping dysuria lower abdominal pain with dizziness and referred shoulder pain severe prolonged vomiting |
trimester 2 common discomforts | Enlarging abdomen backache skin pigmentation striae constipation hemorrhoids heartburn leg cramps(is she getting enough Ca and Mg?) round ligament pain leukorrhea |
trimester 2 danger signs | vaginal bleeding/LOF painful urination fever decreased fetal movement prolonged vomiting abdominal pain/cramping severe swelling visual changes severe headache epigastric pain(pain under right breast) regular uterine contractions calf pain |
3rd trimester common discomforts | SOB leg and foot cramps constipation heartburn pedal edema fatigue urinary frequency Braxton Hicks contractions |
3rd trimester danger signs | Visual disturbances(preeclampsia) hand and facial edema(preeclampsia) fever vaginal bleeding/LOF abdominal pain/uterine contractions(consider gestational age→ bad at 28 weeks, good at 38 weeks) PROM decreased fetal movement |
1st trimester ultrasound use | date of pregnancy Number, size, and location of gestational sac Presence/absence of fetal cardiac and body movements Presence/absence of uterine abnormalities or adnexal masses Cervical length(short) → can cause miscarriage Presence/absence of IUD |
2nd trimester use of ultrasound | Fetal viability, number, position, gestational age, growth pattern, anomalies Amniotic fluid volume Placental location and maturity Uterine fibroids and anomalies Adnexal masses Cervical length |
Optional 8-18 Week Labs/Imaging | Nuchal Translucency Test (11-13 6/7d weeks) (not diagnostic, just gives risk score) Multiple Marker/Quad Screen/Triple Screen Chorionic Villi Sampling (CVS) (10-13 weeks) |
24-28 week labs | Hemoglobin and Hematocrit Diabetes screening *Rh antibody screen (repeat antibody screen for rh- women) Amniocentesis (15-40 weeks) |
32-36 week labs | Ultrasound / ? Biophysical Profile RPR/VDRL Cervical cultures for Gonorrhea/Chlamydia Repeat Hemoglobin and Hematocrit Rectal and vaginal swabs for Group B Strep-Group B Strep (GBS) Test |
initial lab tests | CBC for H&H Blood Type and Rh Factor Antibody Screen Renal Function tests Rubella / Varicella RPR/VDRL Hepatitis B (HBsAg) STI’s and Vaginitis Pap test UA and C&S PPD HIV |
routine prenatal care visits number/weeks | < 28 weeks 6/7--> Q 4 weeks 29-36 weeks 6/7--> Q 2 weeks 37 weeks --> Q week until term |
weight gain amount during pregnancy | 10lbs by week 20, then 1 lbs per week 25-35lbs recommended |
acceptable temp for mom postpartum | 100.4 is fever |
acceptable temp for baby after birth | want to see between 97.7-99.4 |
ABGAR scoring | HR 0-absent, 1<100, 2>100 RR 0-absent, 1-weak cry, 2-good cry color 0-blue, 1-pink with blue extremities, 2-completely pink reflex irritability 0-none, 1-grimace, 2-cry muscle tone 0-no flexion, 1-partly flexed, 2-well flexed |
ABGAR ex. at 1 minute newborn has HR of 105, is crying, is partly flexed, and has blue hands/feet. | 8 |
signs of respiratory distress | Nasal flaring Retractions (Intercostal/Subcostal) Grunting with respirations Increased use of intercostal muscles Seesaw respirations |
benefits of breastfeeding | convenience, health benefits for mom and baby, weight loss, bonding, boosted intelligence, increased dental hygiene |