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What weeks are the first trimester?
Weeks 1 - 13
What weeks are the second trimester?
Weeks 14 - 27
What weeks are the third trimester?
Weeks 28 - 40
Gravidity
number of pregnancies concieved (including miscarriages)
Gravida
number of pregnancies the person has had
Primigradvida
a person’s first pregnancy
Multigravida
a person who has been pregnant 2 or more times
Nulligravida
a person who has never been pregnant
Parity
number of pregnancies that ended after viability (22 weeks)
baby can be born alive or stillborn
Primipara
a person who is giving birth for the first time
Multipara
a person who has borne more than 1 child
Nullipara
a person who has never given birth
Term
pregnancy reaches full gestation (37 weeks)
Pre-term
babies born alive before 37 weeks of pregnancy
Post-term
a pregnancy that lasts 42 weeks or longer
GTPAL
Gravida
Term
Preterm
Aborta
Living
Obstetrician
physician specialized in birth
Midwife
specialized in low risk natural birth
bachelors degree
Doula
support person, advocates and provides emotional and informational support
course
What are the initial lab tests done when someone is pregnant? (4)
CBC
Blood typing + Rh factor
Rubella titer
Pap test
When is the Rhesus factor dangerous? How is this treated?
When the pregnant person is Rh - and the baby is Rh +
Mother gets a shot of immunoglobulin at birth
What are Braxton Hicks contractions and when do they start?
Braxton Hicks contractions are practice contractions that start in the 2nd trimester
When does the distance from the fundus to the pubic bone match the # of weeks?
at 20 weeks
What is different about the mother’s blood volume with uteroplacental blood flow?
At the end of pregnancy, 1/6 of the mother’s blood volume is in the uterus
By the third trimester, what lying position is safest for the baby?
Side-lying position is safest.
In supine position, 2 umbilical blood vessels may become smushed
Quickening
when a pregnant person starts to feel their baby's movement in their uterus (~ 18-20 weeks)
Why do the areola darken when pregnant?
so the baby can see it to breastfeed
Montgomery tubercles
bumps around areola that secrete moisturizer for the nipple
Striae gravidarum
stretch marks
Venous congestion
Blood volume in breasts become fuller, may see venous patterns on breast (this is normal)
What are cardiovascular changes that happen during pregnancy? (2)
Blood volume increases
Circulation and coagulation increase (higher risk for blood clots)
Pica
craving to eat non-food items
How many extra calories does a pregnant person need at the end of pregnancy?
300 - 400 extra calories
What is the reccommended healthy weight gain during pregnancy?
25 - 35 lbs
How can the mother’s folic acid levels at the time of conception effect the baby?
had impact on babies CNS + neural tube
How do healthy fats support fetal development?
Support healthy brain tissue development
How does calcium support fetal development?
Supports bone development
How does vitamin D support fetal development?
supports absorption of calcium, immunity
How does protein support fetal development?
supports fetal tissue growth (including muscle)
Chloasma
“mask of pregnancy”, change in pigmentation
Linea nigra
dark line straight bown belly
Striae gravidarum
stretch marks (scar tissue)
Lordosis
increased curvature of lower back to keep centre of gravity
Diastasis recti
seperation of rectus abdominus muscles
What does progesterone do during pregnancy?
Allows uterus to stretch as it grows
What does estrogen do during pregnancy?
suppresses ovulation, creates energy stores (fat)
What does prolactin do during pregnancy?
causes the breasts to grow and make milk during pregnancy and after birth
What does hCG do during pregnancy?
helps thicken the uterine lining and tell the body to stop menstruating
What are the three components to the first stage of labour?
Latent phase
Active phase
Transition phase
What is the latent phase of labour?
Beginning of the first stage of labour. Irregular contractions
What is the active phase of labour?
Middle of the first stage of labour. Regular, strong contractions, and the cervix is 3-4 cm dialated
What is the transition phase of labour?
End of the first stage of labour. Cervix fully dialated (10 cm)
What is artificial rupture of membranes (ARM)?
Occurs when the care provider intentionally ruptures the amniotic sac
What occurs during the second stage of labour?
Pushing!
What happens between the second and third stage of labour?
The baby is born :)
What occurs during the third stage of labour, and how long is this stage?
The delivery of the placenta, lasts up to 30 minutes
What is the fourth stage of labour?
Immediate postpartum period
How often are fetal vital signs taken during low risk and during high risk pregnancies?
Low risk pregnancy: q 30 mins
High risk pregnancy: q 15 mins
Why do we see the fetal heart beat drop with uterine contractions?
Uterine contractions temporarily restricts oxygen flow
Effacement
cervical thinning
Dilation
cervix opening
What type of opioid is given during early labour vs. active labour?
Early labour: morphine
Active labour: fentanyl
What are the cons of administering opioids for pain management (2)
Risk for respiratory distress
Rapidly lowers heart rate
What are the risks of regional anesthetics / analgesics? (2)
Widespread vasodilation
Hypotension (low bp)
Epidural block
Medication injected into epidural space around spinal chord. Tube stays in place to give a continuous feed of medication
Pudendal block
Injection of medication into the pudendal nerve in the pelvic region
Spinal block
Medication injected into the subarachnoid space in spine
only for c-sections
What is the least effective, but common birthing position?
Lithotomy
Sequelae
Long term heath complication
What are the initial nursing responsibilities to care for the newborn (immediately postpartum) (5)
Clear airway
Assess RR and HR
Stabilize temperature (dry off, skin to skin)
APGAR score
Infant identification and security
What are the components of the APGAR score? (5)
HR
RR
Color
Activity
Reflexes
When is the APGAR score assessed?
At 1 minute after birth, and again at 5 minutes after birth
What is a first degree perineal laceration?
superficial tear
What is a second degree perineal laceration?
extends through skin into muscle
What is a third degree perineal laceration?
Extends through skin, muscle, into anal sphincter muscle
What is a fourth degree perineal laceration?
Extends all the way through anal sphincter muscle and into the anus
Epiostomy
HCP makes incision in perineum
used to be routine, but new evidence proves healing takes much longer with epiostomy compared to perineal lacerations
Oxytocin
Natural hormone that causes uterus to contract
Boggy uterus
not firm, not well contracted, risk for hemorrhage
What are the gestational hypertensive disorders? (3)
Preeclampsia
Eclampsia
HELLP syndrome
What is placenta previa?
When the placenta covers the inside of the cervix, must have c-section
What are the four types of placenta previa?
Low-lying
Marginal
Partial
Complete
What is the fetal mortality rate associated with placental abruptions?
fetal mortality of 50%
What are the risk factors associated with placenta previa? (6)
AMA
Uterine injury
Smoking
Multiple gestations
Hypertension
Short duration between pregnancies
What is placental abruption?
Placenta separates from the uterine wall
What are the risk factors associated with placental abruption? (4)
Hypertension
Recreational drug use
Smoking
Blunt force trauma
What is disseminated intravascular coagulation (DIC)
abnormal systematic blood clotting along bloodstream
What is placenta accreta?
Abnormal placental attachment to the endometrial wall (placenta grows into uterus during pregnancy)
What are the risk factors for placenta accreta? (3)
AMA
Multiparity
Scars in uterus
What are the three types of placenta accreta?
Accreta: placenta firmly attaches to the wall of the uterus
Increta: the placenta is more deeply embedded in the wall of the uterus, but still doesn’t pass through the uterine wall.
Percreta: the placenta passes through the wall of the uterus
What is gestational hypertension?
High blood pressure in pregnancy
What is preeclampsia?
gestational hypertension + proteinuria
With preeclampsia, why is there spilling of protein in urine?
High blood pressure in kidneys damages kidney networks, allowing larger molecules to pass through, like protein
What are the 3 early symptoms of preeclampsia?
Headache
Visual disturbance
Epigastric discomfort
What is eclampsia?
Gestational hypertension effects CNS and causes seizures
What is HELLP syndrome?
Hemolysis (breakdown of RBC)
Elevated Liver enzymes
Low Platelets (poor clotting)
What is gestational diabetes mellitus (GDM)?
a condition in which a hormone made by the placenta prevents the body from using insulin effectively
What are the risks to the mother and baby with gestational diabetes mellitus? (4)
50% will develop type 2 diabetes.
2x more likely to develop hypertensive disorders.
Have bigger babies at birth (macrosomia).
Baby at risk of hypoglycemia at birth.
When is screening for gestational diabetes mellitus done, and how?
At 28 weeks.
Bloodwork taken to establish baseline, injest glucose drink, blood work again after 1 & 2 hours.
What are antepartum (before labour) interventions for GDM? (3)
lifestyle changes
diet
exercise
hydration