OB Exam 1

birth rate

number of births per 1000 people annually

what percentage of pregnancies are unplanned?

50%

what are some common barriers to care?

cost, lack of insurance, transportation, dependent child care

what percentage of delivery is paid for by Medicaid?

43%

what percentage of the population using complementary therapies?

40%

most don’t tell physicians

family medical leave act of 1993

12 weeks of unpaid leave for birth, adoption, or to care for a sick family member

why is prenatal care associated with better outcomes?

early risk assessment, health promotion behaviors

US cesarean birth rate

33%

first time mother c-section rate

24%

what is the rate of having a c-section if you have a history of c-sections?

82%

why is assisted reproduction increases?

increase in technology

increase in maternal age

increased exposure to STIs

when can you be discharged from hospital after birth?

vaginal is 48 hours

c-section is 96 hours

complications may require longer stays

infant mortality rate definition

number od deaths of infants per 1000 live births

What is the current US infant mortality rate?

5.4

Infant mortality rate change from 1950-1990

29.2-9.2

what are some reasons for a decrease in infant mortality?

better neonatal care

back to sleep campaign, decreased SIDS rate

what race is more at risk for preterm birth and LBW?

african americans

poverty and poor prenatal care

what is the rate of death for infants with no prenatal care?

35%

what is the rate of death for infants with prenatal care?

6%

LBW infants have a _______% more chance of death

25%

what does the US rank for infant mortality rates among developed countries?

31st

how many babies die in the first 24 hours of life in the world?

2 million

what are the leading causes of infant mortality?

congenital abnormalities

preterm/LBW

SIDS

RDS
injuries

maternal mortality rate definition

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

how many women worldwide die daily from problems with prenancy and childbirth?

1600

US Maternal Mortality rate

700 die annually

50,000 injuried annually

racial dispartities for maternal mortality

african americans 4x higher than caucasians

hispanics 1.3x higher

you are _____ times more likely to die if you receive no prenatal care

3-4

what % of postpartum deaths occur in the first 24 hours?

45

what is the WHO goal for the maternal mortality rate?

3.3

2021 maternal mortality rate

33

direct causes of maternal mortality

infection, hypertension, obesity, advanced age, repeat c-section, hemorrhage, sepsis

PROVIDERS FAILED TO RECOGNIZE PROBLEM, FAILED TO RESCUE

indirect causes of maternal mortality

malaria, anemia, HIV/AIDS, CV diseases

what are goals to reduce maternal mortality?

improve access to skilled attendants at birth

post abortion care

improved family planning

better reproductive health services

point of care testing

gives data instantly

ex: blood sugar, covid test

standard of care

the level of practice that a reasonably prudent nurse would provide in the same or similar circumstances

pharmacogenomics

how medications interact with the genetic makeup

gene therapy

transplanting normal genes into cells with missing or defective genes to correct genetic disorders

predictive testing

genetic testing to determine whether a person has a gene variant

ex: brca I, breast cancer

presymptomatic testing

genetic test on an asymptomatic individual at risk of a condition to determine if they’ve inherited the mutation

genome

entire set of genetic instructions found in each cell

genogram

pictorial representation of family relationships and health history

genotype

individual’s collection of genes

phenotype

individual’s observable traits, physical traits

karyotype

pictorial analysis of the number, form, and size of the individual’s chromosomes

autosomal abnormalities

abnormal number of autosomes

ex: trisomy 21, extra chromosome

chromosome structure abnormalities

can be translocation, deletions, inversions, aneuploidies

sex chromosome abnormalities

usually issues with the X chromosome

ex: turner syndrome (missing X)

klinefelter syndrome (extra X)

gametes

sperm and ova

females born with set amount that mature at puberty (400,00+)

males produce sperm with shorter life span, several hundred million per day

fertilization

the process by which a sperm and ovum join to form a new cell, zygote

occurs in fallopian tube and zygote travels to implant uterus

chromosomes

46 total, half from mom and half from dad

gametes formed from meiosis

germinal stage

conception through week 2

embryonic stage

3-8 weeks

fetal stage

9-42 weeks

teratogens

environmental agents that can produce a birth defect

TORCHES

toxoplasmosis, other, rubella, cytomegalovirus, herpes, syphilis

what stage of prenatal growth are teratogens most dangerous?

embryonic (3-8 weeks)

threats to prenatal growth and developement

parent’s behavior

TORCHES

mother’s diet and age

illness

what maternal age are at greater risk for pregnancy and birth complications?

adolescents and mothers over 30yo

rubella in pregnancy prior to the 11th week can cause

blindness, deafness, heart defects, brain damage

chicken pox in pregnancy can cause

birth defects

mumps in pregnancy can cause

miscarriage

ectoderm

outer germ layer

epidermis, glands, nails, hair, CNS, PNS

mesoderm

middle germ layer

bones, teeth, muscles, dermis, connective tissue, CV system, spleen, urogenital system

endoderm

inner germ layer

epithelium for respiratory and digestive tracts, glandular cells of organs, roof of yolk sac

amnion

inner cell membrane

develops from interior cells of blastocyst

filmy layer of egg

chorion

outer cell membrane

develops from trophoblast, contains chorionic villi

hard egg shell layer

term amount of amniotic fluid

800-1200mL

what is the purpose of amniotic fluid

cushions fetus and cord

maintains temp

baby drinks it, digests it, puts waste in it

amniotic band syndrome

membranes form down onto baby, limits growth of that body part

oligohydramnios

amount of amniotic fluid is less than expected

less than 300mL

can lead to renal abnormalities

polyhydramnios

more amniotic fluid than expected

more than 2 L

can cause GI issues and other malformations

L/S ratio

lecithin sphingomyelin ratio

2:1 means lungs are mature enough to be born

what is an aminocentesis used for?

L/S ratio

karyotyping

chromosomal abnormalities

gender

yolk sac

aids in transferring maternal nutrients and oxygen until placenta takes over at 20 weeks

size of umbilical cord at term

2cm in diameter, 30-90cm long

there are ____ arteries carrying ______ blood from the baby to the placenta

2, deoxygenated

there is ____ vein carrying _______ blood from the placenta to the baby

1, oxygenated

what is the purpose of wharton’s jelly

surrounds vessels to provide protein

nuchal cord

umbilical cord around neck of baby

what is the purpose of the placenta?

provides for metabolic exchange and oxygen for the baby

provides hormones to maintain pregnancy (HcG, human placental lactogen, progesterone)

ductus arteriosus

shunt from pulmonary artery to aorta because undeveloped lungs don’t need as much oxygen

ductus venosus

shunt that allows oxygenated blood to bypass liver

foramen ovale

shunt from right atrium to left atrium

lecithin

critical pulmonary alveolar surfactant, phospholipid

increases in amount throughout pregnancy

sphingomyelin

pulmonary surfacant, phospholipid

remains constant throughout pregnancy

what is the percentage of multiple gestations?

less than 3%

what amount of couples using fertility drugs (clomid) will have dizygotic twins?

1 in 10

who is at risk for multiple gestations?

older moms, the more children you have

african americans are more likely (1/70 vs caucasians 1/86)

monozygotic twins

one sperm, one egg, ovum split

genetically identical

dizygotic twins

2 separate ovum , 2 separate sperm

no more genetically similar than children

gravida

number of pregnancies regardless of outcome

primigravida

first pregnancy

nulligravida

no pregnancies

multigravida

multiple pregnancies

granmultip

five ore more births, 20 weeks gestation and beyond

greatgrandmultip

10 or more births

abortion

pregnancy ends prior to age of viability (24 weeks)

can be elective or spontaneous

GTPAL system

gravida: number of pregnancies

term births: births 37 weeks and up

preterm births: births 20-36 6/7 weeks

abortions: less than 20 weeks, elective or spontaneous

living children

GPAL system

gravida: number of pregnancies

para: number of pregancies carried to 20 weeks regardless of outcome

abortion: less than 20 weeks

living children