test 2

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?

1. Latent phase

2. Active phase

3. 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