OB Final (Old Information)

obstetrical timeline

birth rate

number of births per one thousand people annually

unplanned pregnancies

50% of US pregnancies

barriers to prenatal care

cost, lack of insurance, transportation, dependant child care, insurance not accepted by the provider

Order of events

medicaid coverage for delivery

43% covered

integrative healthcare

includes complementary and alternative therapies with western medicine, 40% of the population uses complementary and alternative therapies, most people don't tell providers

integrative healthcare examples

chiropractor, herbal medicine, massages

prenatal care

associated with better outcomes, early risk assessment, health promotion behaviors, nutrition, smoking cessation, treatment program for substance abuse

birth providers

physicians and nurse midwives, physicians more common in US, other country's midwives more common (Sweden)

midwife vs physician for birth provider

physicians more expensive due to malpractice insurance needed for MD's, liability coverage cheaper for nurse-midwife

midwife training

in michigan no formal training for "lay midwife", certification available for "certified nurse midwife"

birth settings in the US

most births take place in hospital, small percentage at home or free standing birth center

free standing birthing center

outside of hospital, no anesthesia capability's aka no epidurals and no cesarean, cannot handle complicated births

cesarean birth rates (vaginal bypass delivery)

32.8% of births are cesarean, first-time mothers = 23.9 %, history of cesareans = 81.7%

cesarean birth (vaginal bypass delivery)

surgical incision into abdomen to deliver the baby

VBAC (vaginal birth after cesarean)

vaginal birth of an infant to a woman who has had at least one previous cesarean delivery, higher risk for uterus rapturing

assisted reproduction

recent uptick in these types of births due to societal later pregnancies, the use of medical techniques, such as drug therapy, artificial insemination, or in vitro fertilization, to enhance fertility

early discharge legislation

caginal delivery 48 hours, c-section delivery 96 hours, much teaching required in this time, early outpatient visits after, home visits prn

passed due to "drive through deliveries" where people would be sent home and have complications at home without any help

quiz 1

has lots of stats

be able top put this in order

primarily left side

j=Know mitosis and meiosis and zygoats and gametes

videos?

infant mortality rate

number of deaths per 1000 ;ove births

us infant mortality rates

6.3-6.8 from 1990 onwards, 29.2 from 1950-1990

poverty and poor prenatal care

34.8 versus 6.2 mortality rate if no prenatal care

US rank for infant mortality rate

1-22/28 developed countries

world infant mortality

2 million die in first 24 hours

maternal mortality rates/trends

worldwide 1600 women die each day with problems r/t pregnancy and childbirth

maternal mortality

number of maternal deaths per 100,000 live births related to pregnancy and labor up to 42 days post partum

major causes of maternal mortality

infection, hypertension, hemorrhage (ectopic pregnancy), sepsis, amniotic fluid embolism, a complication of abortions

indirect causes of maternal mortality

malaria, anemia, HIV/AIDS, cardiovascular problems

when do postpartum deaths occur

45% occur within 24 hours

2004 maternal mortality rate spike

caused by obesity, advanced maternal age, number of c-sections

to reduce maternal mortality

improve access to skilled attendants at birth, post abortion care, improved family planning, adolescents reproductive health

point of care testing

Tests performed at the patient's bedside or work of area, using a portable instrument.

association of womens health, obstetric and neonatal nurses (AWHON)

publishes standards of practice and education for perinatal nurses

ethics and OB

abortion, step cell research, impregnation therapy, cord blood banking, cloning

high risk pregnancy

1/5 million out of 4 million total pregnancies in US, defined as one in which life or health of the mother or fetus is jeopardized

categories of pregnancy risks

biophysical, psychosocial, sociodemographic risks, environmental risks

antepartum testing: biophysical assessment

daily fetal movement kick count, done at home, noninvasive, movement is reassuring, should have 10 kicks or movements q2h, less than 3 per hour requires followup

ultrasound biophysical assessment

between 9-12 weeks gestation, another at 18-20 weeks vaginally and abdominally, confirms dates, assesses developmental progress

first trimester ultrasound

confirm pregnancy, confirm viability, determine gestational age, number of baby's, rule out ectopic pregnancy, used for visualisation during chorionic villus sampling, detect maternal abnormalities

second trimester ultrasound

establish or confirm dates, confirm viability, detect polyhydramnios, oligohydramnios, detect congenital anomalies, detect IUGR, confirm placental placement, use for visualization during amniocentesis

polyhydramnios

excessive amniotic fluid

third trimester ultrasound

confirm gestational age, confirm viability, detect macrosomia, detect congenital anomalies, IUGR, determine fetal position, detect placenta abruption, visualization during amniocenteses or version,. BPP, AFI, doppler flow studies, placental maturity

BPP (biophysical profile)

Ultrasound Determination of Fetal Well Being

The higher the score the better the baby is doing, gross body movements, fetal breathing, fetal tone, reactive fetal heart rate,

normal 8-10, equivocal 6, abnormal less than 4

AFI

Amniotic Fluid Index (Determination Made by Ultrasound)

doppler flow analysis

looks at blood flow in the fetus and placenta, fetal adaption and reserve

https://www.youtube.com/watch?v=1rKWuMoWJbU

amniotic fluid volume

via ultrasound, the vertical depths of the largest pockets is measured in all four quadrants. total = AFI

over 25 - polyhydramnios

10-25 is normal

5-10 low normal

less than 5 - oligohydramnios

amniocentesis

amniotic fluid (amniocenteses) risks for mom

hemorrhage, Rh isoimmunization (give rhogam), infection, labor, abruption, amniotic fluid embolism

fetal risks amniocentesis

death, hemorrhage, infection, miscarriage. preterm labor

chorionic villus sampling

10-12 weeks, removes tissue specimen from fetus for genetic screening

PUBS percutaneous umbilical sampling

insertion of needle directly into a fetal umbilical vessel under ultrasound guidance for sampling

https://www.youtube.com/watch?v=Hg10v0Pa5Sc

AFP

maternal serum alpha-fetoprotein, screens for NTD, test of maternal blood, AFP produced by fetal liver, screening ID's those who need follow up, done at 16-18 weeks is preferred, may do 15-20 weeks

NTD

neural tube defects

quad screen

alphas feto protein, estriol, inhibin, hcg

estriol test

one of the three main estrogens, secreted in significant amount in pregnancy

inhibin test

protein complex produced by placenta

coombs test

screening for Rh Incompatibility in RH - mom

fetal monitoring

Nonreactive stress test is not reassuring, contraction stress test, variability (98% accurate in predicting fetal well-being)

gametes

sex cells, either sperm or egg

fertilization

egg and sperm joining together to make zygoat

zygote

made by combination of sperm and egg

ampulla

where fertilization occurs

germinal stage

conception through week 2

embryonic stage

3-8 weeks

fetal stage

9-42 weeks

threats to prenatal development

certain aspects of mothers and fathers behavior, both before and after conception, can produce lifelong consequences

illnesses in a pregnant woman

rubella, chicken pocks

embryonic disk germ layers

ectoderm, mesoderm, endoderm

membranes of the placenta

amnion and chorion

amnion

inner cell membrane develops from interior cells of the blastocyst

chorion

outer cell membrane, develops from trophoblasts, contains chorionic villi on its surface, becomes covering of fetal side of placenta

amniotic fluid

comes from maternal blood via diffusion, increased weekly, term 800-1200 ml total, fetus swallows in and out of lungs, should be clear (thick water)

menscis

smells like merigold

amniotic fluid function

cushion for fetus and cord, temperature, wastes, oral fluid, amniotic band syndrome

amniotic band syndrome

when fibrous bands of the amniotic sac (the lining inside the uterus that contains a fetus) get tangled around a developing fetus

oligohydramnios

too little amniotic fluid, <300 ml, can cause rennal abnormalities

polyhydraminos

>2 liters, can cause gi and other malformations

gtpal and gpal

must practice and know

https://www.registerednursern.com/gtpal-nursing-practice-questions-quiz/

nagel's rule practice

must know

amniocentesis

L/S ratio, karyotyping, chromosomal abnormalities, gender

yolk sac

aids in transferring maternal nutrients and oxygen for the first 5-6 weeks, before the placenta takes over, blood cells and plasma made here

umbilical cord

2 arteries and a vein, at term 2cm diameter, 30-90cm long, wharton's jelly

umbilical cord blood

arteries DEoxygenated, vein OXYGENATED

placenta

metabolic exchange, respiration, nutrition, excretion and storage

placenta hormones

HcG, human placenta lactogen, progesterone

fetal circulation

ductus arteriosis, ductus venosis, foramen ovale

pulmonary surfactants

Surface-active phospholipids that must be present in fetal and newborn lungs to facilitate breathing after birth. keeps them from collapsing.

lecithin

critical alveolar surfactant, increases in amount as pregnancy continues

sphingoomyelin

critical alveolar surfactant, remains constant through pregnancy

L/S ration

2/1 indicates maturity

sensory awareness in utero

24 weeks, taste, temperature changes, light through abdomen, REM

multiple gestations

Twins, triplets, etc

- < 3% if all pregnancies

- 1 in 10 couples using fertility drugs have dizygotic twins

- More likely in older mom

Higher risk pregnancies

- More likely for complications

More likely to deliver prematurely

- Associated problems

Monozygotic Twins

Genetically identical; form a cluster of cells in the ovum splits off within the first 2 weeks following fertilization

Dizygotic Twins

2 separate ova are fertilized by 2 separate sperm; no more genetically similar than 2 siblings

pregnancy testing

detects HcG, false positives and false negatives

false positives pregnancy tests

anticonvulsants, tranquilizers

false negative pregnancy tests

diuretics, promethezine