OB/PEDS Midterm

britney_salinas143

What is an inability to convince after 12 months of trying with a high association of physical and emotional stress.

Infertility

Approximately 1 in _______ woman receive fertility services.

1 in 8

What are 5 factors that increase the chances of fertility?

1) Maintain healthy body

2) Abstain/Quit smoking

3) Prenatal Vitamins

4) Ovulation Tracking

5) Getting Adjusted

When should you refer someone who is

What is a way for you to communicate your wishes to the midwives and doctors who care for you in labor, telling your provider about the labor and birth you'd like to have, what you want to happen, and what you want to avoid?

Birth Plan

T/F: A birth plan is set in stone

FALSE

-- you and your significant other may change your mind, and situations can change quickly during labor and delivery, warranting a change

What are some of the Pros & Cons of Home Births?

Pros:

- comfortable/familiar

- relaxing

- can be surrounded w/ who you want

- less medical intervention

- lower cost

Cons

- not suggested in some cases

- VBAC (more than one baby)

- Less access to interventions

What are some Pros & Cons of Hospital Births?

Pros:

- Access to interventions

- More health professionals

Cons

- Stressful Environment

- Higher cost

- Support restrictions

What is an MD/DO that has completed a residency in obstetrics and gynecology, trained in medical problems during pregnancy, surgeries, C-sections, manage high risk pregnancies, but pay some of the highest malpractice rates of any provider?

OB/GYN

What is a specialist in care of healthy women anticipating a normal pregnancy and birth who focus on wellness, encourage family participation in decision making, trained to identify problems in pregnancy, and work with Obstetrician related to complicated pregnancies/births?

Midwife

What is a woman who serves, providing emotional support and advice for mom and family and suggestions for easing discomfort, such as helping mom with muscle relaxation strategies, change of positions during labor, breathing, or reduction of stress/fear?

Doula

Having a partner or Doula according to research will _________ the occurrence of C-sections, ___________ birth outcomes, __________ interventions, and _________ rates of postpartum depression, so it is important for your pregnant patient to have some kind of support throughout the pregnancy.

REDUCE C-sections

IMPROVE birth outcomes

DECREASE interventions

LOWER rates of PPD

What is a surgical procedure to deliver a baby through incisions in the abdomen and uterus?

Cesarean Section (C-section)

What are two indications for C-Section?

1) Medical Reasons = complications such as placenta previa, fetal distress, breech

2) Elective reasons = scheduled for convenience or avoid labor complications

What is the anesthesia that is needed pre-procedure for C-sections?

Spinal or epidural anesthesia to numb lower body

What is the preparation needed pre-procedure for C-section? (3)

Fasting

IV line placement

Antibiotics

What is done in the recovery room post-procedure for C-section?

Monitoring vital signs and pain management

How long is the hospital stay typically post procedure of the C-section?

3-4 days

What are the activity restrictions post-procedure of C-section?

Limited lifting & physical activity for several weeks

What are 3 short term risks of C-section?

1) Infection

2) Blood clots

3) Bleeding

What are 2 long term risks of C-section?

1) Potential future pregnancy complications

2) Scarring

What is a benefit for the baby of C-section?

Reduced risk of birth injuries

What is a benefit for the mother of C-section?

Controlled delivery environment w/o labor complications

What is 2 considerations that may be more difficult with C-section?

1) Bonding since immediate skin-to-skin contact may be delayed

2) Breastfeeding (may need additional support due to initial discomfort)

What is a vaginal delivery in a woman who has previously had a cesarean section?

VBAC (Vaginal Birth After Cesarean)

T/F: VBAC is eligible for any women who has had a C-section

FALSE

-- suitable for women with a low-transverse uterine scar

NOTE: another indication of VBAC is a desire of vaginal birth to avoid surgery and its associated risks

What is stage 1 of labor and delivery? Stage 2? Stage 3?

Stage 1 = Labor (early, active, transition)

Stage 2 = Delivery of baby

Stage 3 = Delivery of placenta

What is irregular, non-painful contractions that prepare the body for actual labor, with characteristics of *infrequent and irregular*, typically lasting 30s to 2 mins, mild intensity that does not progress, and the pattern of contractions do not become closer together and they do not become more intense over time?

Braxton Hicks Contractions

T/F: Braxton Hicks Contractions can start as early as the first trimester, but they are most common in the third trimester

FALSE

They can start as early as SECOND trimester

-- MC in 3rd tri

What are the 2 purposes of Braxton Hicks Contractions?

1) Uterine preparation (for actual labor)

2) Cervical Ripening / softening of cervix in prep for dilation

T/F: Contracts are regular, progressively stronger, and closer together in Braxton Hicks while True Labor has irregular contractions that do not increase in intensity and may stop with change in activity or position.

FALSE:

Braxton Hicks = irregular, no increase, stop w/ change

True Labor = regular, progressively stronger, closer together

What are 4 management tips for Braxton Hicks Contractions?

1) Hydration (water)

2) Position change

3) Rest (warm bath if uncomfortable)

4) Activity (light exercise such as walking)

How long does early labor last (stage 1 part 1)? What is the level of cervical dilations that occurs during this time?

Hours to days

0-6 cm cervical dilation

What are the contractions like in early labor? Symptoms?

Mild to moderate, irregular, become more regular over time

Symptoms of LBP, cramping, bloody show

What is the bloody show that is released in early labor?

Mucus plug

How long does active labor last (stage 1 part 2)? What is the level of cervical dilation?

4-8 hours

6-8 cm cervical dilation

What are the contractions like during active labor? Symptoms?

Stronger, more regular, closer together (3-5 mins)

Symptoms of intense contractions, possible nausea, and water breaking (if not already)

How long does the transition phase of labor last (phase 1 part 3)? What is the cervical dilation?

30 mins - 2 hours

8 to 10 cm cervical dilation

What are the contractions like in the transition phase? Symptoms?

Very strong, 2-3 mins apart, lasting 60-90s

Symptoms = intense pressure, shaking, irritability

T/F: Contractions during active labor are usually 2-3 minutes apart while contractions during transition phase are 3-5 minutes apart

FALSE

Active labor = 3-5 mins apart

Transition = 2-3 mins apart

What is the thinning of the cervix?

Effacement

How long does delivery of the baby (stage 2) last? What is the cervical dilation?

20 mins - 2 hours

Fully dilated at 10cm

What are the contractions like in stage 2 delivery of the baby?

Very strong, 2-3 mins apart, lasting 60-90s (SAME AS transition)

During stage 2, delivery of the baby, the mother is actively _________ with each contraction, then the baby's head becomes visible which is called ___________, and once the baby is born, the ____________ is clamped and cut.

Actively PUSHES

Baby's head visible called CROWNING

UMBILICAL CORD clamped & cut

How long does stage 3, delivery of the placenta, last?

5-30 minutes after baby is born

What are the contractions like in stage 3, delivery of the placenta?

Mild, help to detach and expel placenta

After placental delivery and the remaining membranes are expelled, what is done to reduce bleeding before any necessary stiches are placed?

Uterus massaged to reduce bleeding

How long does stage 4, recovery, last?

First 1-2 hours after delivery

During stage 4, recovery, the mother and baby are closely ____________, bonding occurs through _____________ contact and initiation of ______________, and the uterus will continue to contract while bleeding decreases.

Closely MONITORED

SKIN-TO-SKIN contact and initiation of BREASTFEEDING

What position is the normal head down position? Is occiput anterior or posterior ideal in this position?

Vertex presentation

Occiput anterior = IDEAL

(posterior = sunny side up birth)

What fetal position is the baby lying sideways across the abdomen?

Transverse Lie

What fetal position is the when the baby is bottom down, with three types being complete, franks, and incomplete?

Breech

T/F: The doctor can turn a baby in breech position by feeling for the head and bottom and turning

TRUE

What are 3 reasons for an intervention in a vaginal birth?

1) Too tired

2) Labor stops progressing

3) Fetal distress

What is a surgical cut to the perineum used to prevent internal tissue damage?

Episiotomy

What is an obstetric emergency where the anterior fetal shoulder becomes stuck on the maternal pubic symphysis, delaying the birth of the baby's body?

Shoulder dystocia

What intervention procedure can cause side effects to the mom such as Episiotomy, Urination issues, and Vaginal tears, but can also result in side effects to the baby including head swelling, bleeding in skull or skull fx, and *shoulder dystocia*?

Vacuum

What intervention procedure can cause side effects in the mom including episiotomy, vaginal tears, hemorrhage, and pelvic floor dysfunction, while side effects to the baby can include bruising, shoulder dystocia (brachial plexus injuries) and trauma?

Forceps

Early cord clamping is usually done _____-_____s after birth, while delayed cord clamping is after ______s

Early clamping = 10-15s

Delayed clamping = 30s

T/F: The umbilical cord can continue pulsating up to 1 minute after birth

FALSE

UC can pulse up to 5 mins after birth

What is a benefit of delayed cord clamping (DCC)?

Allows blood in placenta to travel to baby

-- significant health benefits for baby between 30-60s

What are 4 common post partum infections that can occur?

1) Endometritis (infection of endometrium)

2) Mastitis (breast infection)

3) Infected incision

4) UTI

How are post partum infectons treated?

Antibiotic therapy, rest, fluids, antioxidants

T/F: A new mother with a fever is a clinical red flag and should go to the emergency room or call an obstetrician immediately

TRUE

What are 3 post birth interventions for the baby?

1) Vit K (blood clotting; intracranial bleeding)

2) Hep B Vaccine

3) Erythromycin in the eyes (prevent bacterial eye infections)

How long is a typical pregnancy term last?

40 weeksH

If the first day of the mothers last menstrual period was March 7th, when is the due date?

Date of last period = March 7th

- Go back 3 months (December 7th)

-- Add one year and 7 days (December 14th)

ANS = Dec 14th

Less than ____ weeks is considered premature.

What time frame is considered a viable pregnancy?

20-22 weeks

Most pregancies will be induced at or before ______ weeks since they are post-term

42 weeks

T/F: Every visit will include blood pressure, weight, and baby's heartbeat

TRUE

For routine visits, the first visit from 6-10 weeks will consist of the history, physical exam and labs. Then every 4 weeks in the 1st trimester (7-12 weeks) there is an ________________. Every 4 weeks starting at 2nd trimester (13-16 weeks) consists of labs looking at _____________ changes or _____________ defects. Then every 4 weeks (18-20 weeks) will do an ultrasound to look at ___________. Finally every 4 weeks (24-28 weeks) __________ will be tested.

Ultrasound

Chromosomal changes or Neural Tube defects

Anatomy

Glucose Test (GD)

What is the typical change in maternal weight per week?

1-2 lbs per week

What is made by placental cells and helps to confirm pregnancy as well as possible miscarriage or ectopic pregnancy?

hCG (Human Chorionic Gonadotropin)

hCG doubles every _____ hours in the first _____-_____ weeks.

Doubles every 72 hours in the first 8-11 weeks

What is a protein produced by the placenta early in pregnancy, and if abnormal in levels is a higher risk for chromosomal abnormalities?

PAPP-A (Pregnancy Associated Plasma Protein Screening)

What are 6 contraindications/red flags to adjusting a pregnant patient?

1) Vaginal bleeding

2) abdominal cramping

3) placental abruption

4) Sudden increase of pelvic pain / Ectopic pregnancy

5) Bowel obstruction

6) Elevated blood pressure / pre-eclampsia

Vena Cava Syndrome is when the vena cava is compressed by the baby usually after 20 weeks, and is relieved by laying on the _____________ side

LEFT side

When observing/palpating a pregnant patient, we see postural changes are usually more evident with ____________ lumbar lordosis, ___________ posterior thoracic translation, and causing ________ cervical translation

Increased

Increased

Anterior

Why does the "waddle" occur?

Pelvic bones flare to accommodate baby

T/F: Tenderness and edema can be found in both hyper and hypo mobile segments

TRUE

What is any abnormal biomechanical stressor that could cause negative impact to development, can be applied to any stage of pregnancy and can be related to any biomechanical stress of the baby, but is used in most references to 7th mounth and beyond?

In-Utero Constraint

High maternal distress during pregnancy (ex: anxiety, depression, stress) has been associated with development of childhood ___________ disorders.

Childhood emotional disorders

Early to mid pregnancy ahs been able to predict cognitive outcomes (cognitive ability, attention disorders), late pregnancy the brain is rapidly developing and is highly susceptible to any reduction in O2 or nutrients with anxiety, fearfulness, aggression, or depression possible in ____ trimester, and _____ from childbirth is also linked with negative child outcomes.

3rd trimester

PTSD from childbirth

What is our role for pregnant patients as chiropractors?

Restore biomechanical stability & remove subluxation

-- also support through nutrition, exercise, ADL modification, & listening

What nutrient necessary for pregnancy prevents neural tube defects, when deficient in the mom increases the risk of preterm delivery, can lead to neural tube defects if deficient in the baby, and can come from leafy green vegetables, citrus fruits, beans, or fortified cereals?

Folic acid

What is the recommended daily amount of Folic Acid?

600 micrograms

What nutrient prevents anemia, supports baby's growth and development, when deficient in mom can lead to anemia, fatigue, increased risk of preterm delivery, and when deficient in baby leads to low birth weight, and can be found in lean meats, poultry, fish, fortified cereals, beans, and spinach?

Iron

What is the recommended daily amount of Iron?

27 mg

What nutrient develops the baby's bones and teeth, when deficient in mom leads to maternal bone loss, increased risk of preeclampsia, when deficient in baby leads to poor bone development, and is found in dairy products, fortified plant-based milk, broccoli, kale, and almonds?

Calcium

What is the recommended daily amount of Calcium?

1000 mg

What nutrient helps calcium absorption and supports bone health, when deficient in moms leads to bone softening, increased risk of gestational diabetes, and in babies leads to Rickets, and is found in fortified milk, fatty fish, egg yolks, and fortified cereals?

Vitamin D

What is the recommended daily amount of Vitamin D?

600 IU

What nutrient supports growth of fetal tissue including the brain, deficient in mom leads to muscle mass loss, deficient in baby leading to poor fetal growth, and found in lean meat, poultry, fish, beans, tofu, nuts, and eggs?

Protein

What is the recommended daily amount of protein?

71 g

What can be used as a natural remedy for morning sickness in tea, foods, or other drinks? What is another nutrient that can be used for morning sickness, easily found as a supplement 10-25mg 3x/day and found in fish, beef liver, potatoes, and non citrus fruits?

Ginger

Vit B6

T/F: Prenatal vitamins should only start being taken once pregnant

FALSE

-- should start taking when trying to get pregnant

-- make sure it includes FOLATE!

For the guidelines of safe exercise during pregnancy, you should exercise at least ______ times a week if preferable, avoid competitive activities unless you are a profession/elite athlete, monitor __________ for palpitations and tachycardia, avoid vigorous exercise especially in hot humid weather, and avoid ________ movements.

3x a week

Monitor heartrate (note athletes can get above 140bpm)

Avoid ballistic movements

When checking heart rate and hydration, you should measure heart rate at the _____ of exercise, ensure you rise gradually from the floor to prevent ____________, and drink liquids before, during, and after exercise

Peak of exercise

Orthostatic hypotension

T/F: It is important to start slowly while pregnant if you are a sedentary woman, beginning with low-intensity activities and progress gradually

TRUE