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AWHONN

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201 Terms

1

AWHONN

discusses women’s health as health + illness issues unique or more prevalent in women

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2

regionalization

coordinate cooperative system of maternal + perinatal care w/in geographic area

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3

level 1 care

basic, no complications UNEVENTFUL

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4

level 2 care

some cases

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5

level 2E care

some cases + special care nursery

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6

level 3 care

ALL CASES, special care nursery + NICU

PERINATAL CENTERS

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7

birth rate

# of live births in 1 year/1000 people in population

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8

infant mortality rate

# of deaths of infants under 1 yr/1000 live births in population

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9

fetal death

death in uterus at 20 weeks+ gestation

still birth

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10

neonate death rate #

# of deaths of infants <28 days/1000 births

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11

perinatal death rate

# of neonatal + fetal deaths/1000 liver births

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12

fertility rate

# of live births/1000 women of childbearing age (15-44)

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13

maternal mortality rate

# of maternal deaths from births, complications, childbirth, puerperium during first 42 days after termination of pregnancy/100,000 live births

hemorrhage, hypertension, infections, accidents don’t count

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14

healthy people goal

improve health + wellbeing of women, infants, children, families, and eliminate health disparities

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15

first visit patient history assessment

-past medical history

-current medical history

-gynecologic history

-social history

-religious/cultural history

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16

nagele’s rule

calculates due date

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17

gravida

pregnancy

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18

para

pregnancy delivered past 20 weeks

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19

term births

births (38-42 weeks gestation)

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20

preterm births

births (20-37 6/7)

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21

abortion

pregnancy ends before 20 weeks gestationl

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22

living children

children alive

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23

first visit physical exam

-baseline vital signs

-pelvic exam

  • pelvic adequacy

-vaginal exam

uterine enlargement

-fetal assessment

  • fetal heart tones (after 12 weeks)

  • ultrasoun

    • is there baby, is it alive?

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24

first visit lab work

-H+H, CBC

-ABO, Rh type screen

-VDRL/RPR

-rubella

-hep b surface antigen

-HIV

-urinalysis

-gonorrhea/chlamydia cultures

-pap smear (before preg)

-sickle cells for clients of African descent

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25

prenatal teaching first trimester

-prenatal visit schedule

-dietary needs/restrictions

-hygiene

-activity

TRIMESTER SPECIFIC

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26

first 28 weeks

every 4 weeks (once/month)

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27

until 36 weeks

every 2 weeks (twice/month)

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28

after 36 weeks until delivery

weekly

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29

prenatal checkups

-maternal vital signs

-maternal weight

-fetal heart rate

-fundal height measurement

-urine dip (protein, glucose, ketones)

-ultrasound/vaginal exam maybe

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30

total weight gian

25-35 lbs

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31

weight gain first trimester

3.5-5 lbs

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32

weight gain last two trimesters

1 lb/week

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33

additional calories needed

300 daily

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34

fluid

8-10 glasses/day

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35

first trimester

12 weeks

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36

dietary no’s

-fish

-raw eggs/meats

-listeria

-nicotine, alcohol, drugs

-artificial sweeteners

-caffeine

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37

hygiene

inc vaginal discharge (leukorrhea)

  • soap and water

inc sweating

  • bathe more frequently

bathing/shower safety

  • sitting is good

  • no hot tub

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38

activity and safety

-exercise is beneficial

  • depends on normal activity

  • pelvic tilt, kegels

-shifting center of gravity

  • inc risk for falls

-adequate rest and sleep

  • inc risk for DVTs

-employment

-travel

-pets

  • no cat boxes or dirt in yard= toxoplasmosis

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39

2nd trimester weeks

13-28 weeks

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40

2nd trimester pregnancy changes

-what discomforts

-usually feel best during this trimester

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41

2nd trimester nutrition assessment

1 lb/week or 4 lbs/month

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42

2nd trimester screening

quad screening 15-20 weeks for fetal neural tube defect, down’s syndrome, multiple gestation

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43

danger signs of pregnancy

-vaginal bleeding

-persistent vomiting

-chills/fever

-fluid from vagina

-chest pain

-abdominal pain: ripping or tearing sensation

-s/s of PIH

-changes/lack of fetal movement

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44

s/s oh pregnancy induced hypertension (PIH)

blurred vision, severe headaches,

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45

3rd trimester

week 28-

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46

3rd trimester pregnancy changes

-dyspnea

-backaches

-frequent urination (head on bladder)

-pyrosis

-swelling of hands + feet

-braxton hicks contractions

-inc weight gain, 35 lbs

-fatigue

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47

3rd trimester safety

weekly exams starting 35 weeks

monitor for PIH

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48

3rd trimester prep for childbirth

-childbirth prep classes

-s/s of labor

-braxton hicks bs true labor

-when to call MD/go to doctor

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49

3rd trimester screening testts

1 hr GTT

GBBS vaginal culture

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50

1 hr GTT

24-28 weeks for gestational DM

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51

GBBS

group b beta strep that can be transmitted to baby, need antibiotics

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52

maternal and fetal blood can intermingle when

-trauma

-post amniocentesis (placenta damaged)

-post abortion/miscarriage

-after delivery when placenta separates

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53

rh sensitization

mom produces rh antibodies that are bad for next pregnancies

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54

rhogam

immune globulin

-suppresses immune response

-blood product, get from blood bank

-deep IM injection

-causes soreness at injection site

-risks bloodborne pathogens

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55

indirect coombs

done on mom’s blood, detects antibodies to other blood types

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56

direct coombs

done on baby’s blood

looks for antibodies piggybacked onto baby RBC

positive=antibodies break down rbc risk for jaundice w inc bilirubin

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57

admission assessment

-review of prenatal records

  • complications, due date

-medications/allergies

-last meal

-s/s labor

-status of amniotic membranes

-vaginal discharge/bleeding

-birth plans

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58

labor systemic changes: cardiovascular

inc blood pressure

inc cardiac output

supine hypotension

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59

inferior vena cava syndrome

-pressure on IVC from lying on back

-turn to side

-dec CO

  • dizziness

  • diaphoresis

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60

labor systemic changes: respiratory

inc oxygen consumption

  • inc metabolism

inc respiratory rate

  • paced breathing

possible hyperventilation

  • respiratory alkalosis

  • dizziness + tingling

    • breathe in paper bag, need CO2

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61

labor systemic changes: renal

difficulty voiding

  • dec sensation

proteinuria

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62

labor systemic changes: musculoskeletal

-diaphoresis

-fatigue

-backache

-joint pain

-leg cramps

  • frog legs, stretch them out

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63

labor systemic changes: neurologic

-endorphins

  • inc pain threshold

-perineal pressure

  • dec perineal sensation

  • pressure on nerve endings, dont feel it

  • can tear or episiotomy

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64

labor systemic changes: GI

-dehydration

  • IV, minimal for venous access in case

-dec motility

  • peristalsis stops

-slowed absorption

-N/V

-rectal pressure

  • need to poop? NOPE ITS BABY

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65

NSD

natural unassisted vaginal delivery

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66

why induce labor

doesnt happen, DM, past due, placenta ages

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67

placenta age span

40 weeks

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68

bishop score

prelabor scoring system that predicts

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69

prepidil + cervidil gel

syringe that ripens cervix

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70

cytotec

orally or up cervix

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71

pitocin

oxytocin IV drip titrate 1 mLunit/min

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72

induction warning signs

-happens every less than 2 min

-lasts longer than 90 sec

-above 90 mmhg on IUPC

-uterine resting tone greater than 20 mmhg

-fetal heart rate variations

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73

if hyperstimulation occurs

stops medication ASAP

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74

operative vaginal delivery- forceps or vacuum

2+ station or lower, can see head

indications:

maternal exhaustion

maternal contraindications to pushing

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75

operative vaginal delivery- forceps complications

-fetal ecchymosis, caput succedaneum, cephalohematoma, facial nerve damage, birth canal trauma

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76

fetal ecchymosis

forcep mark

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77

caput succedaneum

edema to scalp

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78

cephalohematoma

hematoma to cranial bone

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79

facial nerve damage

placed incorrectly on face (perm/temp)

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80

birth canal trauma

extensive tears (perm/temp)

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81

operative vaginal delivery: vacuum complications

-scalp trauma

-birth canal trauma

-pop offs

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82

scalp trauma

edema, skin removed

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83

pop offs

suction pop offs, negative pressure leaves mark

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84

pfannenstiel c section

bikini cut

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85

vertical c section

up + down

emergency, obese, appendage to abdomen, had vertical before

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86

LCT uterine incision

like bikini cut on uterus

ONLY ONE THAT CAN HAVE VAGINAL DELIVERY

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87

low vertical uterine incision

low up + down

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88

classical uterine incision

up + down

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89

VBAC: risk for uterine rupture

-only 1 previous c-section

-LCT uterine incision

-adequate pelvis

-monitor FHR

-no augmentation

-physician

-willing consent for c-section in case of complications

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90

delivery complications

-date/time

-type

-incisions/lacerations/repairs

-gender/weight of infant

-apgar scores

-time of placental delivery/assessment

-estimated blood loss

-total length of labor (stages + phases)

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91

premonitory signs of labor

PRIOR TO LABOR OR >10 DAYS BEFORE LABOR STARTS

-lightening (baby drops, descends to pelvis)

-cervical changes

  • soft

  • dilation/effacement (opens + thins)

  • mucus plug sheds (mucusy discharge)

  • bloody show (not a lot)

-braxton hicks contractions

  • prep contractions, will get more frequent

-sudden burst of energy

-rupture of membranes

  • can be first indicator

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92

true labor

-regular contractions

-back to front

-inc intensity + frequency

-cervix dilates + effaces

-walking inc intensity of contractions

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93

false labor

-irregular contractions

-lower abdomen + groin

-don’t inc intensity + frequency

-doesn’t dilate + efface

-walking relieves intensity of contractions

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94

rupture of membranes

complete ROM

  • come to hospital ASAP

leaking bag of water

  • will reproduce fluid

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95

nitrazine test

pH of fluid

yellow= acidic urine

blue= alkaline amniotic fluid

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96

fern test

amniotic fluid under microscope looks like fern tree

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97

amnisure

strip that detects amniotic fluid, expensive

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98

amniotic fluid functions

-buoyancy, floating

-cushions

-protects umbilical cord

-sterile environment

  • pushed to side as baby grows

-thermoregulation

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99

when water breaks

assess

  • check FHR ASAP

  • check for cord prolapse, pelvic exam

document

  • color of amniotic fluid (clear or meconium stained fluid)

  • date/time (want to deliver w/in 24 hrs)

  • method of rupture (SROM, AROM)

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100

meconium stained amniotic fluid

fetal distress in utero

  • rectal sphincter relaxes

  • brown, green or thick fluid

risk for aspiration at birth

  • suction mouth/nose w/ bulb syringe

  • may need to deep suction

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