maternity exam 1

what system is developed first

cardiovascular

heart beating during week 4

presumptive signs of pregnancy

subjective signs perceived by the woman

nausea and vomiting - common wk 2-12

amenorrhea

fatigue

breast changes begin at 2 to 3 wks

probable signs of pregnancy

objective sings

physiological and anatomical changes perceived by the HCP

chadwicks sign - bluish purple coloration of the vaginal and cervix

goodells sign softening of the cervix

uterine and abdominal growth

dkin hyperpigmentation

positive pregnancy test

positive signs of pregnancy

auscultation of fetal heart by 10 to 12 weeks gestation

observation and palpation of fetal movement around 20 weeks

sonographic visualization of fetus

L/S ratio

lecithin and sphingomyelin

if 2:1 ratio demonstrates lungs are mature

around 35 weeks

Lecithin is the main active component of pulmonary surfactant

Sphingomyelin is a nonpulmonary lipid present in the fetal lung before surfactant production ramps up

hPL

human placental lactogen

causes slight insulin resistance so more glucose in blood that can get to fetus and therefore baby has more energy bc glycogen is main energy source for fetus

ductus arteriosus

shunt between aorta and pulmonary artery

allows more blood to shunt away from lungs and instead to body

special adaptations for fetal circulation

increased Hbg oxygen carrying capacity

increased Hbg concentration

increased cardiac output due to increased HR

vessels in umbilical cord

2 umbilical arteries that carry deoxygenated blood from the fetus

1 umbilical vein that carries oxygenated blood to the fetus

amniocentesis

prenatal test of the amniotic fluid

what surrounds the umbilical vessels

whartons jelly as cushion

what do the chorionic vili embed into?

the decidua (endometrium)

cotyledons

lobes of maternal side of the placenta

what forms the fetal side of the placenta

chorionic membrane from trophoblast cells and chorionic vili

oligohydramnios

too little amniotic fluid

what does endoderm form

mucosa of esophagus and intestines and respiratory tract

“inside stuff out”

morula

8 cell division next step is blastocyst

GTPAL

gravity

term birth

preterm birth

abortion - loss before 20 weeks

living children

G#P###

chorion

two layers

outer is trophoblast

inner is mesoderm

mesoderm touches amnion

ectoderm

becomes nail, skin, hair,

outer layer of germ layers

BBT

basal body temperature

rises after ovulation

max fertility window

6 days

sperm lives 5 days

ovum lives 1

GnRH

Gonadotropin-releasing hormone

released from hypothalamus

released during period and continues until ovulation

causes anterior pituitary gland to release FSH and LH

what releases estrogen during proliferative phase

developing follicles

dominant follicle will take over around day 7

dominant follicle will cause spike in estrogen

estrogen spike happens 1-2 days before ovulation

primary fetility signs

BBT - basal body temp

cervical fluid - gets increasingly wet clear and stretchy as ovulation approaches

foramen ovale

shunt between left and right atrium

allows for blood to bypass lungs

Phytonadione

vitamin k

shot given to newborns so they can clot

renal system of newborn

Fully functional at birth

Low glomerular filtration rate – high likelihood of dehydration

More susceptible to overhydration & dehydration

what causes fetal macrosomia

uncontrolled maternal diabetes

Islets of Langerhans

regulate blood glucose levels by secreting hormones

located in pancreas

what type of antibodies cross the placenta

IgG

passive immunity

EDD

estimated date of delivery

how to calculate EDD

take date of first day of LMP (last menstrual period)

minus three months then add seven days

what does Para refer to

the number of pregnancies after 20 weeks

whether live or still births

what antibody type is in breastmilk

IgA

large amounts in colostrum

prima

refers to first

primigravida is first time pregnancy

striae

stretch marks

anemic levels for pregnant women

hemoglobin less than 11

blood volume increases during pregnancy so mild anemia is normal

fetus produces what type of antibody

IgM

by end of first trimester

LH

LH spike causes follicle to rupture and to release ovum

LH helps ovarian follicles mature in the first part of the menstrual cycle

FHR

fetal heart rate

external EFM

Ultrasound transducer records fetal heart rate

TOCO

TOCO

tocodynamometer

measures contractions

cant record intensity

less accurate

FSE

fetal scalp electrode

continuous monitoring

IUPC

intrauterine pressure catheter

objective contraction pressure

how to count duration on EFM

from start of contraction to end of contraction

how long does ductus arteriosus stay open after birth

15 hours

non-shivering thermogenesis

babies metabolize brown fat to use as heat- doesn’t last long tho

types of heat loss in infants

radiation - heat loss thru objects around\

evaporation - water on baby evaporating off

conduction - object baby is laying on takes heat

convection - air flow

axillary temp

36.5 - 37.2 degree Celsius

normal variations in heart rate

sleeping 90-110

crying 160-180

how often go to drs when preggo

every 4 weeks until 28 wks

every 2 wks 29-36 wks

every week 36 wks to 40

FSE

fetal scalp electrode

fetal heart rate

more accurate than ultrasound transducer (external FHR monitor bc that can have gaps when baby moves)

fetal movement assessment

fetal kick count

at least 10 an hour

if less - then do nonstress test

NST

nonstress test

uses EFM to look at fetal wellbeing

can also be preventative measure done weekly if baby is high risk

doppler flow studies

many types of dopplers

used to look at blood flow from placenta to fetus

most often umbilical artery doppler bc placenta has resistance

uses abdominal ultrasound

biophysical profile

NST and US assessment

US assessment

Ultrasound assessment is done with a nonstress test to make up a biophysical profile

US assessment consists of

breathing

tone

movement

amniotic fluid

fundal height assessment

identify growth of uterus

should feel at umbilicus at 20 weeks

measure in centimeters from pubic symphysis to top of fundus

should be +/- 2 cm of gestational age

cell free DNA testing

done in first trimester after 10 weeks

aneuploidy test

RhoGAM dose

300 mcg IM

given 28 wks and within 72 hrs postpartum if needed

how many contractions should you see during labor

5 or less over 10 minutes

external contraction monitoring

palpate uterus

resting tone is soft

if mild contraction - feels like nose

moderate - chin

strong - forehead

how to figure out intensity of contraction using IUPC

take peak IUP and subtract baseline

tachysystole

one of three things

more than 5 contractions in 10 minutes

contractions for less than one minute apart

contractions last for moe than two minutes

this is bad bc doesnt allow proper blood flow to placenta and fetus cant get enough oxygen

fetal heart rate variability

Irregular fluctuations in FHR

Biggest indicator if fetus is getting enough oxygen

want to have moderate variability (6-25 bpm)

chadwicks sign

blueish color of vagina and cervix

probable sign of pregnancy

NT test

nuchal translucency test

11-13 weeks

chromosomal abnormalities

specialized ultrasound that measures the thickness of fluid (nuchal translucency) at the back of the fetus’s neck

appropriate weight gain during pregnancy

para

delivery

primipara - a woman who has delivered once at or beyond 20 weeks’ gestation

MSAFP

Maternal serum alpha-fetoprotein (MSAFP) is a protein produced by the fetus during development. Although the fetus produces AFP, it enters the mother’s bloodstream, allowing healthcare providers to measure its levels through a blood test. High AFP levels may indicate a neural tube defect such as spina bifida, while low levels may suggest chromosomal abnormalities like Down syndrome (trisomy 21) or trisomy 18

during second trimester

16-18 weeks