Day 1 Maternity/OB

Female external genitalia

Labia majora/minora, clitoris, vaginal orifice, urethral orifice

Female internal organs

Ovaries, fallopian tubes, uterus, cervix, vagina

Fertilization

Sperm + ovum unite = zygote

Implantation

Fertilized egg embeds into uterine lining

First Trimester (1-12 wks)

organ formation; most critical period

Second trimester (13-28 wks)

Growth + maternal awareness

Third trimester (29-40 wks)

Fetal wt gain + maturity

Placenta

enhances oxygen,nutrients, waste

Umbilical cord

connects fetus to placenta

Amniotic fluid

Cushions fetus + regulates temp

Dizygotic twins

2 eggs, 2 sacs, 2 placentas

Monozygotic twins

1 egg splits, 1 placenta, 1-2 sacs

Teratogen

any substance causing birth defects

Critical factor

timing of exposure

Alcohol effects on fetus

Causes FASDs

Tobacco effects on pregnancy

low birth wt, pre term labor

Cocaine effects on fetus

microcephaly, placental abruption

Opiods effect on fetus

Neonatal abstinence syndrome

Caffeine

< 200 mg/day is acceptable

Marijuana

affects brain development

Presumptive signs

subjective ( nausea, fatigue, amenorrhea, quickening)

Probable signs

Objective (positive test, goodell, Chadwick, Hegar)

Positive signs of pregnancy

Diagnostic (FHR, ultrasound, fetal movement by examiner)

Goodell sign

Soft cervix (~ 5 wks)

Chadwick's sign

Blueish cervix ( ~6-8 wks )

Hegar sign

Soft uterus (~6- 12 wks)

Blood volume changes

Increase to 50% or 1500 mL

Cardiac output changes

Increase to 50%

Heart rate change

Increased

BP changes

slight decrease

Supine hypotension

uterus compresses vena cava-> avoid lying on back

Progesterone

Relaxes smooth muscle

Psychological Adaption (Rubin) (4 stages)

1. Accept pregnancy

2. Ensure safety

3. Bond with fetus

4. Prepare for motherhood

Antepartum period

Conception -> labor

First prenatal visit

ASAP after confirmation

At what set of wks do we do Transvaginal Ultrasound?

4-5 wks

Abdominal Ultrasound (what weeks)

6-8 wks

Gravida

# of pregnancies

Primigravida

1st pregnancy

Multigravida

2+ pregnancies

Para

Birth > 20 wks

Primipara

1 birth > 20 wks

Multipara

2 + births

Nullipara

no deliveries

Viability

~22 wks

Preterm

20-37 wks

Term

38- 42 wks

Postterm

> 42 wks

GTPAL SYSTEM

G- Total pregnancies

T- > 37 wks delivery

P- 20- 37 wks delivery

A- Abortions (<20 wks)

L- Living Children

Nagele's Rule

EDD = LMP - 3 months + 7 days + 1 year

Early labs

CBC, Blood type, rubella, HIV, hepatitis, UA

First trimester tests

Nuchal translucency, CVS, PAPP-A

Second trimester tests

Quad screen (AFP,hCG, estriol, inhibin A) and Amniocentesis

Assessment at Prenatal visits

Wt, BP, Urine (glucose, protein), FHR (110- 160 bpm), Fundal height

Why do we tell pregnant women to avoid hot tubs

risk neural tube defects

What do we say about positioning after 1st trimester

Avoid supine position

Quickening

the mothers sensation of fetal movement (16- 22 wks)

What is SAFE excercise?

walking, swimming, cycling

What do we tell them to avoid with excercising

contact sports, falling risk, scuba diving

What do we teach about traveling?

safest in 2nd trimester

What do we say to prevent clots?

walk every 2 hrs

What do we say about seatbelts

low across hips