Childbearing Exam 1

Fertile Period for Ova

12-24 hrs after ovulation

Fertile Period for sperm

24 hrs

Best time to try for a baby

• Day of ovulation

• 5 days before ovulation

• 2-3 days before ovulation

What is Organogensis?

when fetal organs are first developing

What can be found at 4 wks gestation?

fetal heart beat

What can be found at 8 wks gestation?

all organs formed

What can be found at 16 wks gestation?

baby’s sex thru ultrasound

Purpose of Amniotic Fluid

• Symmetrical growth

• Freedom of movement

• Protects against mechanical injury (cushion)

• Allows umbilical cord to be free of compression

• Acts as a wedge during labor

What is the Non-Stress Test (NST)?

To assess for reactive FHR in BPP & the intactness of the nervous system

What are you looking for in a NST?

Reactive = good

• ≥2 FHR accelerations of ≥15 bpm

• lasting at least 15 seconds

• within first 20 minutes

What are you looking for in a Biophysical Profile (BPP)?

• fetal breathing

• fetal movement

• fetal tone

• amniotic fluid

• reactive FHR

How is BPP determined?

with an ultrasound

Scoring of BPP

out of 10

• 8-10 = normal

• 6 = questionable

• 4 and below = induce

When would you induce a pt?

BPP score is under 4 regardless of ax

Patient Counseling

• Make certain the client/significant other understands why testing is needed.

• Risks to mother/fetus vs. benefits of information.

• What type of information may be obtained?

• What will the couple/care provider do with the information

Prevention for Breast Cancer

• Exercise

• No obesity

• Reduce fat intake

• Limit alcohol intake

Risk Factors for Breast Cancer

• BRCA1/2 gene mutation

• No preg or first preg after 30 yo

• Never breastfed

• Early menarche & late menopause

• Hormone therapy

Screening for Breast Cancer

• Exam q1-3 yrs (25-39 yo)

• Annual for 40+ yo

• Mammogram 45+ yo

S/S of Breast Cancer

• Painless mass/lump

• Breast pain but no lump

• Discharge

• Dimpling

• Skin changes

• Nipple inversion

Main risk factor for Breast Cancer

Age & Gender

Contributing Factors of DV

• Traditional views

• Patriarchy

• Childhood exposure to violence

• Desire for control

• Marital conflicts

• unemployment/poverty

• Substance use

• Emotional dependency/insecurity

First Step of Cycle of Violence

Tension building

• Possessiveness, controlling, blaming

• Women accepts responsibility

• Isolation, threats, name calling, arguments

Second Step of Cycle of Violence

Acute battering incident

• Shock, denial, disbelief by batterer

• Rationalizing & minimizing

• Shortest

Third Step of Cycle of Violence

Making-up/Tranquil Phase

• Love bombing

• Dependence

Signs of Abuse

• Vague complaints

• Lack of eye contact

• Increased anxiety

• Hesitation

• Defensive injuries

• Late prenatal care, premature labor

Situational Crisis for Rape Trauma Syndrome (RTS)

• acute/disorganization

• Outward adjustment

acute/disorganization in RTS

Emotional symptoms & alterations in sleep

Outward adjustment in RTS

• Denial & suppression

• May receive less support

Reorganization of RTS

• Alter self-concept & resolve herself

• Develop long-term health problems

Integration/Recovery in RTS

• Recognizes she is not to blame

• Trusts others

• Feel safe again

Osteoporosis

• Thin & porous; increase risk of fractures

• Highest risk: white & asian

Risk Factors for Osteoporosis

• 50+

• Menopause

• Family history

• Low body weight/thin

• Inactive

• Lack of Vit D, Ca, fruits & veggies

• smoking

Preterm Labor

Labor between 20 - 37 wks

What is the #1 cause of infant death & disability?

Preterm Labor

Risk for Preterm Labor

• Age

• Alcohol, smoking, & drugs

• Bleeding after 12 wks

• Cervical insufficiency (painless dilation w/o contractions)

• Cerclage: stitch cervix together

• Low socioeconomic status

• Non-white race

• No prenatal care

S/S of Preterm Labor

• Abd, back, & pelvic pain

• Cramps

• Vaginal bleeding

• Pelvic pressure

• Increased vaginal discharge

• Urinary frequency

• Diarrhea

What is fetal fibronectin (fFN)?

• Glycoprotein at interface

• In vaginal secretion prematurely → indicates preterm birth

Diagnosis of Preterm Labor

• Contractions q5min for 20 min OR 8 contractions in 60 min

• Cervix change or cervical dilation

Management/Interventions of Preterm Labor

• stop/slow labor

• Bed rest/hydration

• Betamethasone (fetal lung development)

• Tocolytics (slow contractions)

What is a Spontaneous Abortion?

A loss of a pregnancy before 20 wks

Greatest Risk for a Spontaneous Abortion

Old Age

Classes of Spontaneous Abortion

• threatened

• imminent/inevitable

• incomplete

• complete

• missed

Threaten Abortion

Unexplained

• cramping, backache

• closed cervix

Imminent/Inevitable Abortion

• increased bleeding & cramping

• dilated cervix

Incomplete Abortion

• parts are retained

• dilated cervix

Complete Abortion

All part expelled

Missed Abortion

• fetus dies but not expelled

• closed cervix

Management for Abortion

• bed rest

• emotional support

Folic Acid

• Affects Hgb

• important for DNA/RNA synthesis

Folic Acid Deficiency

• prevalent in twin preg

• can lead to neural tube defects (spina bifida, etc)

Treatment for Folic Acid Deficiency

• leafy greens

• OJ

• red meat

• fish

• poultry

Iron Deficiency

• due to increased blood volume

• most common

Maternal Risks of Iron Deficiency

• Susceptible to infection

• Tire easily

• Risk of PIH

• Risk of post-partum hemorrhage

• Delayed tissue healing

• Poor tolerance to normal blood loss during birth

• Cardiac failure

Fetal Risks of Iron Deficiency

• Low birth weight

• Stillbirth, neonatal birth

Iron Supplement Teachings

• take on a empty stomach w/ Vit C

• Tarry stool & constipation is normal

Rh Incompatibility

• Rh+ dad & Rh- mom → Rh+ fetus

• Occurs in second baby; triggered by first baby

Diagnosis of Pre-Eclampsia

>140/90

after 20 wks w/ proteinuria

Worsening S/S of Pre-Eclampsia

• Edema

• N/V

• Worsening headache & blurred vision

• epigastric/shoulder pain

• Decreased UOP

• Hyperreflexia

• disorientation/confusion

What leads to pre-eclampsia?

Hypoxia of placenta → immune response → vasospasm & capillary injury → S/S

Treatment of Pre-Eclampsia

• Delivery

• Mag sulfate - to prevent seizures

Diagnosis of Severe Pre-Eclampsia

• >160/110

• + / - proteinuria

• possible cerebral/neurologic or end-organ involvement

S/S of Severe Pre-Eclampsia

• PE

• Headache or visual disturbances

• Elevated liver enzymes

• Renal insufficiency

• Thrombocytopenia

Eclampsia

Tonic-clonic seizure

Intervention of Eclampsia

• Maintain airway

• Position on side to avoid aspiration

• Side rails up

• Admin mag sulfate

Hyperinsulinemia

First trimester: estrogen & progesterone → higher amounts of insulin secreted → increase glycogen stores

What happens after the first trimester regarding GDM?

• Increased tissue resistance to insulin

• 2nd & 3rd trimester

• Glycogen levels decrease → elevated post prandial blood sugars

Risk of GDM

• HTN

• vascular disease (neuropathy, retinopathy)

How does the body ensures the fetus gets enough glucose?

• Mild fasting hypoglycemia

• Post-prandial hyperglycemia

• Hyperinsulinemia

Maternal Risk with GDM

• Hydramnios: increase in amniotic fluid

• Eclampsia

• Labor Dystocia

• Recurrent UTIs

Fetal Risk with GDM

• Macrosomic Infant (BIG)

  • From poor glucose control

  • Result: high level of fetal insulin production

• Respiratory Distress Syndrome (RDS)

  • High levels of fetal insulin inhibit surfactant production

• Severe congenital anomalies

• Intrauterine Growth Restriction (IUGR)

  • From potential vascular damage

• Increased risk of stillbirth

• Hypoglycemia

• Hyperbilirubinemia

Ectopic Pregnancy

Ovum implanted anywhere but endometrial lining

Common location of Ectopic Preg

Common locations: ampulla of fallopian tube

Risk of Ectopic Preg

• Tubal damage & anomalies

• History

• Endometriosis

• IUD presence

• Ovulation-inducing drugs

• Smoking

• Old age

S/S of a Ruptured Ectopic Preg

• Bleeding

• One-sided & diffuse lower abdominal pain

• Fainting, dizzy

• Right shoulder pain

Premature rupture of membranes (PROM)

>37 wks

Maternal risk: infection (Chorioamnionitis)

Fetal risk: premature & infection

Preterm Premature rupture of membranes (PPROM)

<37 wks

Tests for amniotic fluid presence

• Fern Tests

• Nitrazine paper

Antepartum

from conception to onset of labor

Intrapartum

from onset of labor to birth

Postpartum

form birth to when the body returns to normal (6 wks)

Gestation

number of wks since LMP

Abortion

birth before 20 wks

Types of Abortion

Spontaneous: miscarriage

Therapeutic: medically induced

Preterm Labor

birth between 20 - 37 wks

Stillbirth

born dead after 20 wks

Term

born 37+ wks

Nulligravida

never been preg

Primigravida

first time preg

Multigravida

2+ preg

Nullipara

not given birth at >20 wks

Primipara

one birth at >20 wks (regardless of outcome)

Multipara

2+ births >20 wks (regardless of outcome)

GP-TPAL

Gravida

Para

-

Term

Preterm

Abortion

Living

Gravida

total # of preg (regardless of outcome)

Para

birth >20 wks (regardless of outcome)

Uterus Changes during Preg

• Walls = thicker

• Braxton-Hicks contractions (painless, irregular)

  • To stimulate blood flow

Cervix Changes during Preg

• Mucus plug

• Goodell’s sign: cervical softening

• Chadwick’s Sign: blue-purple discoloration

Vaginal Changes during Preg

more & thick mucus

Breast Changes during Preg

• Grow

• Superficial veins

• Nipples

  • Pigmented

  • Erect

Respiratory Changes during Preg

• O2 consumption increases → SOB

• Diaphragm = elevated

• Thoracic breathing

• Congestion from estrogen edema