unit 3 pregnancy OB

The maternal uterine arteries deliver the nutrients to the ______, providing nutrients and oxygen to the developing fetus.

placenta

The umbilical cord contains one large vein and two small arteries known as ______.

AVA (1 vein, 2 arteries)

______ (a specialized connective tissue) surrounds these three blood vessels in the umbilical cord to prevent compression, which would cut off fetal blood and nutrient supply.

Wharton jelly

In utero, the umbilical ____ carries oxygenated blood instead of unoxygenated. In utero, the umbilical ____ carry the unoxygenated instead of oxygenated blood.

veins; arteries

The focus of _____ is to reduce the risk of adverse health effects for the woman, fetus, and newborn by addressing modifiable risk factors and providing education about having a healthy pregnancy.

prenatal care

  The placenta acts as a pass-through between the mother and fetus but it is not _______ Almost everything the mother ingests (food, alcohol, and drugs) passes through to the developing fetus.

a barrier even though it is termed the placental barrier.

Amniotic fluid is derived from two sources:

fluid transported from the maternal blood across the amnion (the innermost membrane that encloses the embryo) and fetal urine

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_____ is the total number of times a woman has been pregnant, regardless of whether the pregnancy's resulted in a termination or if multiple infants born from a pregnancy.

Gravida/gravidity

_____ is the number of times a woman has given birth to a fetus of at least 20 weeks gestational weeks (viable or not), counting multiple births as one birth event.

Para

_____ refers to gravida, term births, pre-term births, abortions, and living children.

GTPAL

The _____ can change and is estimated & helps to plan visits and prenatal care as the pregnancy progresses.

estimated due date

The recommended follow-up visit schedule for a healthy pregnant woman is:

Every 4 weeks up to 28 weeks, after 28 weeks it’s every 2 weeks, and after 37 weeks it’s every week.

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Fundal measurement (used to measure fetal growth) should approximately equal _____ until week 36. It is a measurement in centimeters from the symphysis pubis to the top of the uterine fundus.

the number of weeks of gestation

When a woman perform’s her “fetal kick count,” _____ per hour (in a span of less than 2 hours) is the magic number.

10 kicks per hour

Screening for gestational diabetes through a one-hour glucose tolerance test is best done between____ and _____ gestation.

24 and 28 weeks’

Between ___ and ___ gestation, assessment for edema begins with special attention is focused on the presence and location of edema during the last trimester.

29 and 36 weeks

If the mother is __,__ her antibody titer is evaluated. RhoGAM is given if indicated. RhoGAM is used to prevent the development of antibodies to Rh-positive red cells. It is also recommended for prophylaxis at_ and following birth if the infant is Rh-positive.

Rh-negative; 28 weeks gestation

An average human pregnancy lasts for _____ from the date of the last menstrual period (LMP).

40 weeks

The gametes (ovum or sperm cells) must each have a set of ___ to come together to form the zygote that needs a combined total of _______ to avoid abnormalities in the pre-embryotic stage.

23 chromosomes; 46 chromosomes

______ is a safe test that provides important information about fetal activity, growth, and gestational age; assesses fetal well-being; and determines the need for invasive intrauterine tests.

Obstetric ultrasound

The______ measures (AFP, hCG, unconjugated estriol, and inhibin A) and identifies fetal risk (trisomies 13, 18, and 21) and neural tube defects. (optional)

Quad screen

______ screening (ultrasound) is also done in the first trimester between 11 and 14 weeks. This allows for early detection and diagnosis of some fetal chromosomal and structural abnormalities.

Nuchal translucency

_______ involves a transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis. The fluid contains fetal cells that are examined to detect chromosomal abnormalities and several hereditary metabolic defects in the fetus before birth.

Amniocentesis

______ is an invasive procedure involving an 18-gauge needlestick through the abdomen or passage of a suction catheter through the cervix under ultrasound guidance. This test is used to obtain a sample of the chorionic villi from the placenta for prenatal evaluation of chromosomal disorders.

Chorionic villus sampling (CVS)

________ sampling procedure involves passing a needle into the abdomen, through the amniotic sac and into the umbilical vein.

Percutaneous umbilical blood

A reactive NST includes at least two fetal heart rate accelerations from the baseline of at least 15 bpm for at least 15 seconds within the 20-minute recording period. If the test does not meet these criteria after______, it is considered nonreactive.

40 minutes (requires further testing)

A positive CST (stimulating nipple to release oxytocin) means persistent and consistent late deceleration of FHTs with 50% or more contractions and indicates an ______.

Abnormal Finding

In a biophysical profile, a score of ______ is considered normal if the amniotic fluid volume is adequate.

8 to 10

A score of ______ is suspicious in a biophysical profile, possibly indicating a compromised fetus; further investigation of fetal well-being is needed.

6 or below

An ___ zygote will become a female, and an ___ zygote will become a male (determined during fertilization).

XX; XY

An increase in _____, found in prenatal vitamins, is essential before pregnancy and in the early weeks of pregnancy to prevent neural tube defects in the fetus.

folic acid

____ is essential for fetal growth and brain development and in the prevention of maternal anemia.

iron

Regardless of weight (BMI), we never want to put a mother on a diet. Instead the nurse wants to do what? 

Encourage healthy foods like increased fruits and vegetables

A nurse needs to emphasize to the pregnant patient to avoid the consumption of fish with moderate to high mercury levels. The nurse understands the patient has understood this when she states what?

“I will avoid foods that are high in mercury, especially fish found in the deep sea (Shark, Tuna and Mackerel).”

A_______ is any substance, organism, physical agent, or deficiency state present during gestation that can induce abnormal postnatal structure or function by interfering with normal embryonic and fetal development.

teratogen

\*Cocaine is considered a teratogen because it causes ______.

placental abruption, prematurity, and/or microcephaly

Alcohol consumption is considered a teratogen under the drug category because it causes ____ in babies.

fetal alcohol spectrum disorder

____ is the stage where it is determined if a pregnant woman is going to have twins ( (identical or fraternal).

Pre-embryonic stage

Identical twins (also called monozygotic twins) occur when ______. Identical twins have the same genes, so they generally look alike and are the same sex.

one fertilized egg splits and develops into two

Fraternal twins (also called dizygotic twins) develop when_______ .

two separate eggs are fertilized by two different sperm

During the embryonic stage, the_____ originates and is a thin protective membrane over the embryo that contains amniotic fluid (amniotic sac). Basic structures of all major body organs and the main external features are completed during this time period, including internal organs.

amnion

A heartbeat is present at this stage and it is also considered the longest period of prenatal development.

fetal stage

To manage urinary frequency or incontinence, the nurse may suggest the following:

Pelvic floor exercises to increase control over leakage.

Empty your bladder when you first feel a full sensation.

Avoid caffeinated drinks (stimulate voiding) \n \n

In monosomies, there is only ____________ instead of the usual pair (an entire single chromosome is missing). In these cases, all fetuses spontaneously abort in early pregnancy.

one copy of a particular chromosome

The risk of trisomy 21 and other trisomies increases with_______.

maternal age (greater than 35 “geriatric over 35”).

Small, low-set ears that may fold over a little at the pinna in _______.

trisomy 21 (down syndrome)

Common characteristics in down syndrome include:

o   Small hands and feet

o   A short neck

o   Almond-shaped eyes that slant upward

o   Deep crease across palm (termed a simian crease)

o   Short stature in childhood and adulthood

o   Small mouth with protruding tongue

o   Broad, short fingers

____ and ___ are conditions associated with a high degree of infant mortality, with most dying before their first birthdays

Trisomy 18 & 13

_______, also termed Martin–Bell syndrome, is a structural abnormality involving the X chromosome, which demonstrates breaks and gaps. It is a common form of intellectual disability and autism spectrum disorder.

Fragile X syndrome

_______ syndrome is a rare genetic disorder in which a variable portion of the short arm of chromosome 5 is missing or deleted.

Cri du chat (“cat’s cry syndrome”)

Clinical manifestations in the structural abnormality ____ include a low posterior hairline and webbing of the neck due to the X chromosome completely missing.

turner syndrome

 ______ is a sex chromosomal abnormality that occurs only in males. In this syndrome, an extra X chromosome (XXY) is present. The extra genetic material causes abnormal development of the testicles.

Klinefelter syndrome

Autosomal dominant inheritance disorders occur when a single gene in the heterozygous state is capable of producing the phenotype. In other words, the______, and the individual will demonstrate signs and symptoms of the disorder.

abnormal or mutant gene overshadows the normal gene

Autosomal recessive inheritance disorders occur when two copies of the mutant or abnormal gene in the homozygous state are necessary to produce the phenotype. In other words, ______ are needed for the individual to demonstrate signs and symptoms of the disorder.

two abnormal genes

  X-linked inheritance disorders are those associated with_______. They differ from autosomal disorders. If a male inherits an X-linked altered gene, he will express the condition. Because a male has only one X chromosome, all the genes on his X chromosome will be expressed (the Y chromosome carries no normal allele to compensate for the altered gene).

altered genes present on the X chromosome

Multifactorial inheritance disorders are thought to be caused by _______ and environmental factors. Many of the common congenital malformations, such as cleft lip, cleft palate, spina bifida, pyloric stenosis, clubfoot, developmental hip dysplasia, and cardiac defects, are attributed to multifactorial inheritance.

multiple genetic (polygenic)

What type of fish should a pregnant women avoid?

anything in the deep sea such as swordfish and marlin due to their high levels of mercury

Ingesting high levels of mercury while pregnant can potentially:

damage the fetus’s nervous system

What daily vitamin is recommended daily for women?

folic acid to prevent neural tube defects during preconception

What are the normal hematocrit (HCT) levels and hemoglobin (hgb) and why are these important?

33-36% and 12-16 mg/dl; it is an indicator for iron deficiency anemia

A serum iron less than ___, a total iron binding capacity (TIBC) greater than ____, and ferritin less than ____ are used to confirm a diagnosis of iron deficiency anemia.

35, 430, 100

Why is iron deficiency anemia important to diagnose early on?

the mother feels fatigued and is more susceptible to infections

Iron deficiency anemia affects the fetus how?

increases risk for low birthweight, premature birth and even stillbirth

What are good sources of iron?

shellfish, apricots, peanut butter, spinach, red meat, green leafy vegetables

_____ enhances the absorption of heme from dietary and supplemented form or iron ingested.

vitamin C (Citrus foods such as oranges, strawberries, tomatoes)

(true/ false) During the 2nd trimester, the woman need an additional 300 calories per day to support fetal growth.

true; teach the patient she is not eating for two

What hormone is detected in pregnancy tests?

HcG (Human chorionic gonadotropin)

What is seen on an ultrasound at 8 weeks?

fetal pole, cardiac activity, gestational sac that confirm pregnancy

Presumptive signs of pregnancy include:

nausea/vomitting, breast tenderness, fatigue, amenorrhea, urinary frequency

Probable signs of pregnancy include:

positive pregnancy test (elevated hcg)

softening of the cervix **(Goodell sign)**

bluish-purple coloration of the vaginal mucosa and cervix **(Chadwick’s sign)**

presence of Montgomery glands

(true/false) Routine prenatal care for a low-risk pregnancy includes 1 visit every 4 weeks until 28 weeks’ gestation, 1 visit every 2 weeks until 36 weeks’ gestation, and then weekly visits until birth.

true; this changes if the pregnancy is high risk

An elevated MSAFP indicates ____.

an increased risk for an open neural tube defect

A ______ involves drinking a concentrated glucose solution and then measuring a blood glucose level one hour later. It is a screening procedure to identify insulin resistance. If the glucose challenge results are elevated, the patient would be scheduled for a 3-hour glucose tolerance test to dx whether or not she has gestational diabetes.

glucose challenge

What are the positive signs of pregnancy?

hearing fetal heart sounds, visualization of the fetus on ultrasound, palpation of fetal movement

As pregnancy grows, the center of gravity shifts and the lower back gradually starts to curve more. This postural change is known as ___.

lordosis

What patient education can the nurse provide to a women experiencing heartburn?

eat six small meals a day

do not eat within 2 hours of bedtime

elevate head above stomach when lying down

avoid spicy and fried foods

During pregnancy, the GI system slows down, causing constipation. How does the nurse educate the pregnant women to decrease this?

increase fiber

drink 8-10 glasses of water

take a 20 minute walk everyday

An average human pregnancy lasts for 40 weeks from the date of the ______.

last menstrual period (LMP).

Implantation occurs in the upper uterus called the ____.

fundus

all major body organs and the main external features are completed during ______.

embryonic stage

A monochorionic-monoamniotic twin pregnancy is from one shared ovum (egg), meaning they share ONE amnion and amniotic sac. This only happens with identical twins and is considered a high-risk pregnancy due to____.

the risk of entanglement from umbilical cords since each twin has their own

A monochorionic-diamniotic twin pregnancy occurs in fraternal twins. Each twin has their own amniotic sacs but there is only one placenta. What is this pregnancy at risk for?

a high risk of the twins fighting for blood supply (meaning one losing and passing away)

What signs are usually not felt until the third trimester of pregnancy?

Braxton Hicks contractions (practice contractions felt around 35-38 weeks) & Ballottement (pushing against cervix during a pelvic examination & rebounds)

______ levels of hCG can indicate multifetal pregnancy, ectopic pregnancy, hydatidiform mole pregnancy or genetic abnormality. _______ than normal expected hCG levels might suggest a miscarriage.

Higher levels; lower levels

Increased progesterone causes a thick mucus plug to form that blocks the cervical os and protects the opening from ______.

bacterial invasion.

Pregnant women are more susceptible to infections. A typical discharge experienced by pregnant women is a _______ and is normal unless it is accompanied by itching and irritation (candidiasis).

whitish vaginal discharge called leukorrhea

Progesterone is what sustains pregnancy (placenta). If a women comes into the clinic with low progesterone, what does the nurse need to suggest?

supplemental progesterone to avoid miscarriages.

Pregnant women may experience cardiovascular problems during pregnancy. Maternal hypotension tends to occur due to the weight of the uterus on the vena cava (in supine position). What does the nurse need to educate the women on to prevent supine vena cava syndrome?

Teach patient to lay on left side in semi-fowler’s position or place wedge under one hip when supine (laying)

A pregnant women experiences a sudden drop in her blood pressure while she is standing. What is the nurses priority?

slowly sit the patient to nearby bed/chair/floor

T__oo little amniotic fluid__ (less than 500 mL at term), termed __________ is associated with uteroplacental insufficiency, fetal renal abnormalities, and higher risk of surgical births (not enough fluid to cushion baby during labor) which causes them to be low-birth-weight infants.

__oligohydramnios__,

__Too much amniotic fluid__ (more than 2,000 mL at term), termed __________, is associated with maternal diabetes, neural tube defects, chromosomal deviations, and malformations of the central nervous system and/or gastrointestinal tract that prevent normal swallowing of amniotic fluid by the fetus.

polyhydramnios

The nurse tells the patient that is only 14 weeks pregnant they must _____ before a amniocentesis because amniotic fluid will be aspirated under ultrasound guidance.

empty bladder prior to procedure

High levels of alpha-fetoprotein after an amniocentesis indicate ____.

neural tube defects

Low levels of aloha-fetoprotein after and amniocentesis indicate ____.

chromosomal disorders

If a patient undergoes an amniocentesis, what must the nurse administer to a Rh-negative mother after the procedure?

RhoGAM

Abruptio placenta is highly triggered by cocaine. The placenta separates from the uterus that may lead to maternal and fetal mortality. What is the hallmark sign of this complication?

intense uterine pain with dark red bleeding with signs of hypovolemic shock (hypotension, tachycardia, pallor)

The mother’s ide of the placenta is called the ____.

dirty Duncan

The baby’s side of the placenta is called the ____.

shiny Shultz (what nurses see in labor)

In utero, the umbilical ____ carries oxygenated blood instead of unoxygenated.

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vein

In utero, the umbilical _____ carry the unoxygenated instead of oxygenated.

arteries