childbearing exam 1

chorion

outer layer of fetal membrane; anchors placenta to uterine wall

amnion

inner layer of fetal membrane; contains amniotic fluid

umbilical cord should have ___ holes

3

3 holes in umbilical cord:

1 vein, 2 arteries

fetal veins

carries oxygenated blood and O2 from mom into fetal circulation

fetal arteries

carries deoxygenated blood and waste to umbilical cord back to mom

what hormones does placenta produce?

hCG, human placental lactogen, progesterone, estrogen

hCG

human chorionic gonadotropin; pregnancy hormone (detected in urine if pregnant)

human placental lactogen

ups insulin resistance, sends glucose to placenta

progesterone

keeps smooth muscle loose (prevent contraction before labor)

estrogen

increased vascularity and dilation; increased blood to placenta

fetal stage: pre-term

after viability (20 weeks) to 37 weeks

fetal stage: term

entering week 38 to week 41

(e.g. 37 weeks and 1 day)

fetal stage: post-term

after 42 weeks

how many weeks is viability?

20 weeks + 500g

abortion

less than 20 weeks + 500g

which system is the first to function in fetuses?

cardiovascular system

hematopoieses begins in the ___ in the ___ week

liver; 6th

what L/S ratio is considered mature?

2:1 (approx. 35 weeks gestation) for respiratory system

what is the main route for bilirubin excretion?

placenta (managed by liver)

Most newborns void within ___ of birth

24 hours

what antibody is not produced by the fetus and is only present in colostrum?

IgA

GTPAL: G

Gravidity: total number of pregnancies (including current pregnancy)

GTPAL: T

number of term births

GTPAL: P

number of pre-term births (20-37 weeks)

GTPAL: A

number of abortions

GTPAL: L

number of currently living children (does not count fetus in belly)

Presumptive, probable, or positive? Breast changes

presumptive

Presumptive, probable, or positive? amenorrhea

presumptive

Presumptive, probable, or positive? nausea/vomiting

presumptive

Presumptive, probable, or positive? urinary frequency

presumptive

Presumptive, probable, or positive? fatigue

presumptive

Presumptive, probable, or positive? quickening

presumptive

Presumptive, probable, or positive? Goodell’s Sign

probable

Presumptive, probable, or positive? Chadwick’s Sign

probable

Presumptive, probable, or positive? positive pregnancy test

probable

Presumptive, probable, or positive? Braxton Hicks Contractions

probable

Presumptive, probable, or positive? Ballottement

probable

Presumptive, probable, or positive? visualization of fetus by ultrasound or x-ray

positive

Presumptive, probable, or positive? presence of fetal heart tones

positive

Presumptive, probable, or positive? fetal movements palpated by examiner

positive

Amenorrhea

no period

quickening (+ when does it occur)

first time feeling baby move (~18-22 weeks)

Goodell’s Sign

soft cervix

Chadwick’s Sign

vagina and cervix have bluish hue due to increased vascularity

Braxton Hicks Contractions

cramping of uterus during early pregnancy - painless, cramp-like, irregular

Ballottement

fetal head bounces against finger when pushing down on cervix

pregnancy blood test

if number of hCG doubles in 48 hours, that’s a pregnancy

(if it increases, but not double, could be ectopic)

Naegele’s Rule

first day of LMP - 3 months + 7 days + 1 year

what is the correlation between fundus height and weeks gestation?

fundus height (in cm) = weeks gestation

e.g. 20 weeks gestation = fundus 20 cm

Lightening/Fetal Drop

descent of fetus into pelvis

when does lightening/fetal drop occur in a nulliparous woman?

2 weeks before labor

when does lightening/fetal drop occur in a multiparous woman?

start of labor

cervix should be ____ in nulliparous woman

round

cervix should be ___ in a multiparous woman

slit-like

striae gravidarum

stretch marks (veins become more prominent)

blood volume (increases/decreases) during pregnancy

increases

normal hemoglobin and hematocrit (increases/decreases) during pregnancy

decreases (physiologic anemia!)

there are (increased/decreased) clotting factors in pregnancy

increased

urinary frequency during ____ trimesters

1st and 3rd (not 2nd)

facial chloasma/melasma

hyperpigmentation in face, nose, forehead, etc. (fades after birth)

linea nigra

hyper pigmented line follows uterus on stomach (stripe of pregnancy)

the fundus is at umbilicus at ___ weeks

20

a woman who has had multiple pregnancies can feel quickening (sooner/later)

sooner

when are fetal heart tones audible?

10-12 weeks

first trimester

week 1-13

second trimester

week 14-26

third trimester

week 27-delivery

what vitamin is most important in preventing ONTD?

folic acid

when mom should have prenatal visits

Q4 weeks until 28 weeks

Q2 weeks until 36 weeks

Q week until they deliver

immunizations that are NOT ok for pregnancy

MMR (Rubella)

varicella

yellow fever

polio

immunizations that ARE ok for pregnancy

HepB + HepA

rabies

flu

COVID

most at risk time for teratogens

weeks 2-8

toxoplasmosis symptoms

Fever, fatigue, headache, swollen lymph glands, muscle aches /pains 

Baby: hearing issues, blindness, neurological deficits (crosses placenta!)

how is toxoplasmosis contracted?

hand to mouth after gardening or cleaning litter box

eating raw meat (or touching to mouth)

what does RPR and VDRL measure/test for?

syphilis

Rubella exposure associated with ___

SAB, congenital anomalies, hearing loss, psychomotor retardation

rubella diagnosis

antibody titers >1:8 = immunity (e.g. 1:20)

antibody titers <1:8 = susceptible (e.g. 1:4)

signs and symptoms of rubella

Rash, muscle aches, joint pain

Newborn: Hearing loss Cataracts Cardiac Defects

how is Cytomegalovirus (CMV) transmitted?

close contact (kissing, sex, breastfeeding, transplacental)

signs and symptoms of CMV

Women are usually asymptomatic

Fetal/Neonatal Complications: Intellectual disability,  hearing deficits, microcephaly

How is herpes transmitted?

vaginal delivery during active outbreak or due to ascending infection after ROM (rupture of membranes)

what are the fetal-neonatal risks of herpes?

SAB, preterm labor, development of HSV, death

what should the mother’s blood pressure be?

should stay the same before and after pregnancy

what is considered hypertensive in the mother?

systolic > 140

how should the mother gain weight during pregnancy?

very little weight gain in beginning

by 20 weeks: gain 10 pounds

after 20 weeks: 1 lb/week until delivery

Nuchal Translucency Test

PNC < 14 weeks

assess fetal neck to detect for Down syndrome and other abnormalities

Quad Screen

done between 16-18 weeks

gives risk factor for Down syndrome and neural tube defects

Down syndrome contains (low/high) levels of MSAFP

low

Neural Tube Defects contain (high/low) levels of MSAFP

high

1 Hour Glucose Challenge Test (GCT)

1. Mom gets sugar drink

2. Draw blood 1 hour after finishing drink (no fasting - normal day)

   • Fail = glucose > 140

3 Hour Glucose tolerance test (GTT)

done if GCT is abnormal

1. Fasted glucose test (draw blood)

2. Give double amount of sugar drink

3. Draw blood 1, 2, 3 hours after drink

   • If 2/4 values fail (too high), that is diagnosis of gestational diabetes

Normal levels for GTT: fasting

95

Normal levels for GTT: one hour

180

Normal levels for GTT: two hours

155

Normal levels for GTT: three hours

140

normal Hemoglobin level during pregnancy

> 11 g/dL

normal Hematocrit level during pregnancy

>33%

when to give mother RhoGAM

28 weeks, after invasive procedure/trauma, within 72 hours postpartum

Rh sensitization

Rh- mother with Rh+ fetus

sensitization = mother produces antibodies against baby’s Rh+ blood cells, causing harm to the baby