Women's Health - Exam 1

Antenatal Care, Conception, Labor/Birth Management

cochrane pregnancy and childbirth database 6 categories for ranking studies

• forms of care that are beneficial

• forms of care that are likely to be beneficial

• forms of care with a trade-off between beneficial and adverse effects

• forms of care with unknown effectiveness

• forms of care that are unlikely to be beneficial

• forms of care that are likely to be ineffective or harmful

Joanna Briggs institute 3 grades of recommendation

• A: strong support that merits application

• B: moderate support that warrants consideration of application

• C: not supported

outcomes-oriented care

measures effectiveness of care against benchmarks/standards

outcome and assessment information set (OASIS)

required in medicare accredited facilities

nursing outcomes classification (NOC)

effort to identify outcomes and related measures that can be used for evaluation of care of individuals, families, and communities across the care continuum

organizations that publish standards for nursing

ANA, AWHONN, ACNM, NANN

standard of care

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

negligence

when the standard of care is not met and harm results

sentinel event

an event that is not due to underlying conditions or the natural course of a client’s condition that affects a client, resulting in death, permanent harm, or severe temporary harm

failure to rescue

the failure to recognize or act on early signs of distress

3 primary germ layers of placenta

ectoderm, mesoderm, endoderm (entoderm)

ectoderm develops into

epidermis, glands, nails, hair, CNS, PNS, lens of eye, tooth enamel, floor of amniotic cavity

mesoderm develops into

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

endoderm (entoderm) develops into

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

embryo

lasts from 15 days to 8 weeks after conception

teratogens

substances or exposure that cause abnormal development

chorion

develops from trophoblast and contains chorionic villi on surface

amnion

inner cell membrane, develops from interior cells of blastocyst

amniotic cavity

between inner cell mass and outer layer of cells (trophoblast)

amniotic fluid

initially derived by diffusion from the maternal blood in the first trimester, regulated by a balance between fetal fluid production (lung liquid and urine) and fluid resorption through fetal swallowing and flow across chorionic and amniotic membranes to the maternal uterus and the fetus

amniotic fluid functions

• maintains fetal body temperature

• source of oral fluid

• repository for waste

• assisting in maintenance of fluid and electrolyte homeostasis

• provides the fetus with resistance to movements

• cushion fetus from trauma by outside forces

• provides auditory stimulation

• has antibacterial factors

• facilitates normal fetal lung development

oligohydramnios

<300 mL of amniotic fluid, associated with fetal renal abnormalities

hydramnios/polyhydramnios

>2 L of amniotic fluid, associated with GI and other malformations

yolk sac

another blastocyst cavity formed on the other side of the developing embryonic disk, becomes surrounded by a membrane

umbilical cord

connecting stalk compresses in from both sides to form this, contains 2 arteries and 1 vein

wharton’s jelly

connective tissue that surrounds the vessels to prevent compression and ensure continue nourishment

nuchal cord

when umbilical cord is wrapped around fetal neck

naegele’s rule

rule for estimating date of birth with LMP, subtract 3 from month add 7 to day add 1 to year

gravida

a woman who is pregnant

gravidity

pregnancy

nulligravida

a woman who has never been pregnant and is not currently pregnant

primigravida

a woman who is pregnant for the first time

multigravida

a woman who has had 2 or more pregnancies

parity

the number of pregnancies in which the fetus or fetuses have reached 20 weeks of gestation or more, not number of fetuses born (not affected by whether fetus born alive or stillborn)

nullipara

a woman who has not completed a pregnancy with a fetus or fetuses who have reached at least 20 weeks of gestation

primipara

a woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation or more

multiplara

a woman who has completed two or more pregnancies to 20 weeks of gestation or more

preterm

a pregnancy that has reached 20 weeks 0 days of gestation but ends before 37 weeks 0 days of gestation

late preterm

a pregnancy that has reached between 34 weeks 0 days and 36 weeks 6 days of gestation

early term

a pregnancy that has reached between 37 weeks 0 days and 38 weeks 6 days of gestation

full term

a pregnancy that has reached between 39 weeks 0 days and 40 weeks 6 days of gestation

late term

a pregnancy that has reached between 41 weeks 0 days and 41 weeks 6 days of gestation

postterm

a pregnancy that has reached 42 weeks 0 days and beyond of gestation

viability

the capacity to live outside the uterus, there are no clear limits of gestational age or weight

2-digit system of documenting obstetric history

• G: gravida

• P: para

5-digit system of documenting obstetric history

• G: gravida

• T: term

• P: preterm

• A: abortion

• L: living

placenta structure

grows from trophoblast, complete by 12th week

placenta functions

• endocrine: HcG, hPL/hCS, progesterone, estriol

• metabolic: respiration, nutrition, excretion, storage

human chorionic gonadotropin (HcG)

maintains estrogen and progesterone, shows up on pregnancy tests and first to rise

human placental lactogen (hPL)/human chorionic somatomammotropin (hCS)

prepares/stimulates lactation, increases insulin resistance

progesterone

pro-pregnancy hormone, maintains endometrium and decreases contractility

estriol

one of the main estrogens produced by the placenta, promotes lactation and uterine growth/blood flow

fetus

8+ weeks gestational age

where does fertilization occur?

in the uterine tube within 24 hours of ovulation

when does implantation begin?

6 days after fertilization

first trimester duration

first day of LMP to 13 weeks 6 days

second trimester duration

14 weeks 0 days - 27 weeks 6 days

third trimester duration

28 weeks 0 days through 40 weeks 6 days

hyperplasia

production of new muscle fibers and fibroelastic tissue

hypertrophy

enlargement of pre-existing muscle fibers and fibroelastic tissue

hegar sign

softening and compressibility of lower uterine segment

braxton hicks

intermittent uterine contractions felt through the abdominal wall soon after the 4th month, enhance blood flow

factors that decrease uterine blood flow

• low maternal arterial pressure

• uterine contractions

• maternal supine position

uterine souffle/bruit

rushing or blowing sound of maternal blood flowing through uterine arteries to placenta that is synchronous with maternal pulse

funic souffle

caused by fetal blood coursing through umbilical cord, synchronous with fetal HR

ballottement

passive movement of unengaged fetus, generally can be identified between 16-18 weeks of gestation; bounce it gently and feel it rebound

quickening

first recognition of fetal movements (“feeling life”)

goodell’s sign

softening of cervical tip observed at about beginning of 6th weeks; due to increased vascularity, slight hypertrophy, and hyperplasia

friability

tissue easily damaged, can result in slight bleeding after vaginal examination

operculum

increased mucus production by endocervical cells which fills endocervical canal to form the mucus plug, acts as barrier against bacterial invasion of uterus

chadwick sign

violet-blue color of vaginal mucosa and cervix, evident at 6-8 weeks of pregnancy

leukorrhea

white or slightly gray mucoid vaginal discharge with faint musty odor

why is there no ovulation during pregnancy?

estrogen and progesterone suppress FSH and LH

striae gravidarum

stretch marks, can appear at outer aspects of breasts

lactogenesis stage 1

during the second trimester, human placental lactogen stimulates secretion of colostrum

epulis

red, raised nodule on gums that bleeds easily

ptyalism

excessive salivation

pyrosis

heartburn/acid indigestion

intrahepatic cholestasis

retention and accumulation of bile in liver, can occur late in pregnancy

melasma

blotchy, brownish hyperpigmentation of skin over cheeks, nose and forehead

linea nigra

pigmented line extending from the symphysis pubis to the top of the fundus in midline, known as linea alba before pigmentation

angiomata

tiny star-shaped/branched, slightly raised, and pulsating end arterioles usually found on neck, thorax, face, and arms

palmar erythema

pinkish red, diffusely mottled, or well-defined blotches are seen over the palmar surfaces of the hands

diastasis recti abdominis

rectus abdominis muscles can separate, allowing abdominal contents to protrude at the midline

carpal tunnel syndrome

edema involving peripheral nerves can cause this during last semester

isoimmunization

occurs when Rh- mother has Rh+ fetus who inherits dominant Rh+ gene from father

erythroblastosis fetalis

fetus compensates for hemolytic anemia by producing large numbers of immature erythrocytes to replace those lysed

hydrops fetalis

most severe case of Rh incompatibility, fetal anemia can cause this; marked anemia, cardiac decompensation, cardiomegaly, hepatosplenomegaly, hypoxia

exchange transfusion

needed for severe anemia or hyperbilirubinemia, replaces RBCs by circulating maternal antibodies

TORCH infections

infections that can cross the placenta - toxoplasmosis, other infections (e.g. hepatitis), rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV)

presumptive signs of pregnancy

subjective, changes felt by the woman

• secondary amenorrhea (missing period)

• breast changes (4 weeks after LMP)

• change in sense of smell

• nausea and vomiting

• urinary frequency

• extreme fatigue

• chloasma, linea nigra, vulvar changes

chloasma

hyperpigmentation of face, usually butterfly-shaped

probable signs of pregnancy

objectives, changes observed by examiner

• goodell’s sign

• chadwick’s sign

• hegar’s sign

• positive pregnancy test

• enlarging abdomen

• braxton hicks contractions

• fetal movement

positive signs of pregnancy

definitive signs attributed only to presence of the fetus

• embryo or fetus identified on ultrasound

• fetal heart tones auscultated

• fetal movement felt by examiner

traditional schedule of prenatal care visits

• 1-2 visits in first trimester

• 3-4 visits in second trimester

• visits Q2W from 28-36 weeks

• weekly visits >36 weeks

baseline diagnostic screenings in pregnancy

• urine check

• urine culture

• pap smear if needed

• chlamydia, gonorrhea, syphilis

• CBC

• rubella titer

• blood type and RH

• hepatitis B

• HIV

• possibly CF and sickle cell genetic screens

H&H norms in pregnancy

• Hgb: 12-16 g/dL

• Hct: 37-47%

ABO incompatibility

determined by Coombs test

• Mom: O

• baby: A, B, AB

when is Rho(D) immune globulin (RhoGam) administered?

• after any vaginal bleeding

• after any blunt force trauma to abdomen

• at 28 weeks EGA

• after delivery

fetal testing in first trimester

• cfDNA

• ultrasound screening for nuchal translucency

• chorionic villus sampling