OB Exam 1: Statistics, Fam, Culture, Genes

What impacts fertility rates? (5)

1. age: declines w/ age (especially > 32y/o)

• bad egg quality

2. elevated or low BMI disrupts hormones

3. diet

4. smoking

5. exercise

What factors contribute to high mortality rates in US? (7)

1. limited access to pre natal care

2. high prevalence for obesity/HTN

3. food desert

4. transportation

5. racial disparities

6. income

7. lack of familiar support

Maternal mortality vs morbidity:

mortality: deaths of pt during pregnancy

morbidity: acute/chronic health complications d/t pregnancy or childbirth

What are some leading causes of maternal morbidity and mortality? (5)

1. excess blood loss and postpartum hemorrhage (PPH)

2. infections

3. sepsis

4. cardiovascular events (embolisms, strokes, HTN)

5. mental health disorders (suicide, drug use)

How can beneficence and autonomy conflict in care?

When a pt refuses tx that the nurse believes is safest

• ex: recommending c-section for moms safety but she wants a natural birth

What injury prevention strategies do maternal newborn nurses teach? (4)

1. safe sleep

2. car seat safety

3. fall prevention

4. infx prevention

What are postpartum blues?

• when does it resolve?

• mild, short term mood changes affecting many new moms

• - resolves w/in 1-2 weeks

Whats postpartum depression?

• when does it happen

• persistent sadness, hopelessness w/in 12 months of birth that interferes w/ daily functioning and bonding with baby

Whats postpartum psychosis?

• when does it start?

• develops w/in 2-3 weeks of postpartum period

• rare severe mental health emergency w hallucinations and delusions

  • may harm themselves or newborn!!!

How have recent legal issues affected reproductive healthcare in US? (2)

1. restrictions on abortions

2. decreased availability in some states for family planning

What interventions help reduce maternal morbidity rates? (5)

1. better access to prenatal/postpartum care in poor areas

2. have standard protocols for managing high-risk pregnancies (HTN, preeclampsia)

3. early screenings

4. lifestyle counseling

5. chronic disease management (DM, HTN etc)

How does midwifery integrate w/ traditional maternal healhcare?

• midwives work alongside physicians to give care for LOW risk pregnancies

  • provide prenatal, labor, and postpartum care

Whats the benefits and challenges of @ home births?

• benefit:

1. more personalized care and comfort

2. fewer interventions for low risk pregnancies

• challenges:

1. limited access to emergency care if complication arises

Whats the benefits and challenges of hospital births?

• benefit:

1. immediate access to interventions and emergency care

• cons:

1. less individualized care

2. higher infx risk

3. higher rate of medical intervention

How do SDOH affect maternal newborn outcomes? (7)

1. income

2. education

3. housing

4. transportation

5. access to healthcare

6. nutrition

7. stress

What is cultural awareness in maternal healthcare?

• recognizing that different cultures exist and understanding ones own biases

What is cultural competence in maternal healthcare?

Actively applying cultural knowledge to provide respectful, individualized care

Whats primary, secondary, tertiary, quaternary prevention in maternal newborn care?

1. primary: preventing problem b4 they occur

• ex: prenatal vitamins, vax, healthy lifestyle

2. secondary: early detection

• ex: pap smear, colonoscopies, mammograms

3. tertiary: manage existing conditions to reduce complications

• ex: chemo, pain management, cardiac rehab

4. quaternary: avoiding unnecessary medical interventions that could be harmful

How should nurses screen for interpersonal violence or substance use disorder?

1. private, calm setting

2. use HITS questionaire

3. active listening, silence, empathy, clarify, etc…

4. non-judgmental care

What are assessment questions used to assess cultural factors related to childbirth? (6)

1. who should be present?

2. are there foods that are appropriate/ inappropriate during pregnancy, birth and postpartum?

3. are there any beliefs/customs that prohibit physical activity during pregnancy?

4. how would u like to express pain during childbirth?

5. are there any precautions youd like to take w infant care?

6. how many visitors do u expect while ur in hospital?

Whats Trisomy 21?

• Down Syndrome

• xtra 21 chromosome → disability and physical features

  • flat nose

  • wide eyes

  • short neck

  • smaller ears

  • protruding tongue

Whats Turner Syndrome?

• features: (5)

Females: only one functioning X chromosome (XO)

• short stature

• infertile

• low hair line

• wide chest/neck

• amenorrhea

Whats Klinefelter Syndrome?

• signs: (8)

• Males: has extra X chromosome (XXY)

  1. infertile

  2. low testosterone

  3. long limbs

  4. increased height

  5. small balls

  6. delayed puberty

  7. increased risk for breast cancer

  8. female hair distribution

How does Trisomy 21 differ from sex chromosome anomalies?

• trisomy 21 affects overall development

• while sex chromosome disorder mainly affect sexual development

What are 3 1st trimester screenings taken?

1. Cell Free DNA

2. Chorionic Villus Sampling (CVS)

3. Nuchal Translucency Testing

Whats Cell Free DNA?

• BLOOD test after 10 weeks that screens for chromosomal abnormalities

Whats CVS and whos it mainly for?

• whens it done?

Chorionic Villus Sampling

1. INVASIVE diagnostic test done @ 10-13 weeks to detect genetic disorders

2. cells from placenta gotten through cervix

3. for high risk pregnancies (> 35 y/o)

Whats some risks of CVS? (4)

1. increases risk of fetal hemolytic disease

• fetus Rh+ and mom is Rh-

2. spontaneous abortions

3. rupture of membranes

4. infx

Whats Nuchal Translucency Testing?

• USN measuring fluid behind the fetal neck to asses for risk for chromosomal abnormalities @ 11-13 weeks

  • Detect trisomy 21

Whats targeted carrier screening?

• examples?

• pros and cons?

• tests for specific genetic conditions based on ethnicity or fam hx

  • ex: AA pts have higher risk of Sickle Cell Anemia

  • Jews, French, Canadians have higher risk for Tay-Sachs

• Pros:

1. lower cost

2. focused and well-studied

cons:

1. many missed conditions outside selected test

What expanded carrier screening?

• ex? (3)

• pros and cons?

• screens for 100+ genetic disorders regardless of background

• carriers have the gene

  • ex: cystic fibrosis, sickle cell, Huntington’s

• Pros:

1. more inclusive

2. IDs unexpected risks

• Cons:

1. higher cost

2. increases anxiety

What are universal screenings for babies? (3)

1. Blood chemistry (not targeted)

• PKU: Heel Stick

2. Hearing": ID’s congenital hearing loss

3. Cardiac

What does the Blood Chemistry test for?

• metabolic disorder (PKU/Hypothyroidism)

• done @ 24-48 hrs of life

How is Newborn Cardiac Screenings done?

• Pulse Ox to detect critical congenital heart defects