ts pmo 1

explain GTPAL

• Gravidity: total # of preg

• Term birth: born 37 weeks minimum

• Preterm: 20-36 weeks born

• Abortion/miscarriages

• Living children

preconception factors (3)

• health promo

• risk assessment

• interventions

BMI and weight gain

• <18.5: 28-40lbs

• 18.5-24.9 (normal): 25-35

• 25-29.9: 15-25

• >30 (obese): 11-20

prevention of neural tube defects

• low risk: 0.4mg before and duing

• moderate risk: 1mg 3 months prior then 0.4 after first trim

• high risks": 4mg/day 3 months before preg, 0.4-1mg after first tri

menstrual cycle (e, h, o)

1) endometrial

2) hypothalamic-pituitary

3) ovarian

explain the 4 parts of endometrial phase during menstrual cycle (mpsi)

1. menstrual (d1 to ~5d, where 2/3 of endometrium sheds)

2. proliferative: D5-ovulation where there is rapid regrowth of endometrium

3. secretory: ovulation to 3d before period, corpus luteum secretes progesterone to prep for nutrients/thicker tissues

4. ischemic: no implantation the corpus luteum breaks down, ⬇estro and proges, necrosis, period bleeding

what process must occur to maintain func of corpus luteum

production of beta hCG by trophoblasts

explain the hypothalamic-pituitary part of the menstrual cycle

• end of period

• GNRH stims release of FSH for some estrogen feedback loop

• LH then causes ovulation

explain the ovarian part (3/3) of the menstrual cycle

• 1-30 follicles mature from FSH then LH

• empty follicle becomes corpus luteum to support possible preg

where does ovulation occur

ampula

beta HCG

confirmation of pregnancy

when is beta hCG released

8-10 days after conception

signs of pregnancy (pre, pro, po)

• presumptive

• probable

• positive

nagele’s rule for EDB

(first day of last period) - 3 months + 7 days + 1 year

3 layers of uterus

1. endometrium (innermost)

2. myometrium

3. perimetrium

purpose of connective and elastic tissues in uterus

stretching for birth

external os

cervix and vagina

when do trophoblasts cells invade endometrium (week)

week 3

functions of placenta:

• endocrine gland

• metabolic (respiration, nutrition by simple diffusion, excretion, storage

if corpus luteum dont work before placenta provides enough estrogen and progesterone what happens to pregn

miscarriage

what is the connecting stalk in relation to the umbilical cord

gets squeezed to become cord

what are the veins and arteries to fetus

• 2 arteries carrying deoxygenated blood from embryo

• 1 vein gives o2 to fetus

normal amt of amniotic fluid

700-1000mL

oligohydramnios

amniotic fluid <300mL

polyhydramnios

amniotic fluid is >2000mL

purpose of amniotic fluid

• constant body temp

• cushioning

• freedom of movement

• barrier for infection

• fetal lung dev

• waste area

• prevents fetus from tangling in cord

maternal adaptation

1. accepting preg

2. identifying w/ role

3. reordering relations

4. establishing relat with child

5. prep for birth

paternal adapation

1. accepting preg

2. identifying with role

3. reord relations

4. establishing relationship with bby

5. prep for birth

sibling adaptation for bby (age groups)

• 1 yr: unaware

• 2: notices moms change but might unaware

• 3-4: curious and worried about baby

• School age: interests and views self as mother/fathr

• early/middle adolescence: preoccupied with sexual ident

• Late adolescents: comforting to parents, behaves like adults

from what times are the first trimester

conception to 12 weeks for ovum, embryonic, and fetal stages

ovum stage of first trimester

• conception to day 12

1. conception

2. implantation

3. embryonic disk (primary germ layers from where all body systs come from)

embryo stage of first trimester

• d15 to 8wks

• development of 3 germ layers

• CRUCIAL TIME OF DEVELOPMENT

• heart rate also comes along

3 primary germ layers

1. ectoderm: makes baby pretty

2. mesoderm: makes baby strong

3. endoderm: epithelium lining of respir and digestive tracts

maternal development in first trimester

• reproductive: uterine growth and sensitive boobs

• cardio: DBP⬇, HR ⬆, ⬆cardiac output

• renal: more pee

• GI: lower appetite from N&V, heartburn

hyperemesis gravidarum

• extreme form of n&v that starts in first 10 weeks

• S&S: weight loss, electrolyte imbalance, nutritional deficiencies

• risks: young age, nulliparous (first preg), over/underweight, low SES, PMx

• maternal and fetal complication

nursing care and management: hyperemesis gravidarum

• physical exam

• watch out oral intake

• iv therapy

• other non medical treatments (including CBT)

early pregnancy loss

• before 20 weeks w/o abortion

• causes: chromo issues, endocrine imbalances, immune issues, systemic disord, genetic, infections

• S&S: uterine bleeding, cramping, lower back pain

types of pregnancy loss (TIICM)

• threatened

• inevitable

• incomplete

• complete

• missed

nursing care and management for early pregnancy loss

• asessment: VS, LMP, preg Hx, allergies, N&V, LOC, pain, bleeding, emotional distress

• confirmation of preg

• treatment: expectant care, medical management (misoprostyl), surgical management

• health teaching: bleeding, infection, iron supplement, emotional support, wait 2month before next

misoprostol use

for miscarriages, uterine tonic (contraction)

Methotrexate

treats cancer by slowing down growth of cancer cell by decrease hydrofolic acid enzy

ectopic pregnanCy

• fertilized ovum implants outside of uterus

• S&S: delayed menses, abnormal bleeding, abd pain to one side, shoulder pain, shock, cullen sign (bruise at belly button)

nursing care and management for ectopic preg

• phys assssment

• lab tests

• medical management: methotrexate

  • health teaching: no foods/vits with folic, no gassy foods, no sex until hCG lvls are undetectable, no meds stronger than acetaminophen, next preg 6-7 months

molar pregnancy/hydatidiform mole

• happens when another sperm fertilizes already fertilized 

• benign growth of trophoblast

• risks: prior GTD, >40 yo, early teens

• S&S: bleeding (prune), pre-eclampsia, hyperthyroid

nursing care and management for molar pregnancy/hydatidiform mole

• assessment

• labwork: hCG is really high

• suction curettage (surgery)

• NO UTEROTONICS bc of embolization

• contraceptive use for 1yr

U/S findings

• gestational sac visible with beta hCG >1500

• FHR at 6wk

• dating u/s 8-12 weeks

• viability at 12 weeks

• nuchal translucency (NT) 11-13+6 wk

fetal aneuploidy

one or more extra or missing chromo

enhanced first trimester screening (eFTS)

• US for NT and maternal serum biochem markers

• 11-14 wks

noninvaisive prenatal testing (NIPT)

• maternal blood

• offered if risk factors present

• strict criteria for OHIP

chorionic villi sampling (CVS)

• sample of tissue from placenta

• 10-13 weeks

• done if eFTS or NIPT is positive

vitamin a in pregnancy

BAD

exercise in preg

moderate

alc, smoking, and substance use during preg

HELL NO (no amt is safe esp in 3-8 weeks)

immunizations during preg

• NO LIVE VAX

• recommended: TDAP, influenza, COVID, HPV

rhogam

• if mom is Rh neg and baby is Rh pos, baby can develope antibodies against antigen so next baby gets attacked

• rhogam prevents formations of antibodies

second trimester is from

13-27 weeks

fetal viability

22-25 weeks BUT it depends on condition

when can mom feel baby move

20 weeks

when can baby hear

24 weeks

maternal development

• reproductive syst: uterus size increases, braxton hicks (tightening), vag is sensitive, big boobs

• cardio: sl hypertrophy

• respiratory system: rib cage expansion from progesterone and more vascularized upper respiratory tract means prone to infection

• integumentary: hyperpigmentation, chloasma, linea nigra, stretch marks

• gastrointestinal: N&V should resolve

when is anatomy scan

18-22 weeks

GDM screening: concerning values

• 7.8-11: more testing to confirm but u prob have

• 11.1: u have it

amniocentesis

• if NIPT test returns positive, do this

• amniotic fluid is taken out with needle and teste

• ppl at risk: >40yrs, FHx, previous child with genetic issue

when is third trimester

28 weeks to term (37-40)

third trimester: maternal development

• reproductive: lightening (fetal descent so its pushing bladder instead of lungs) and colostrum but no lactation rn

• cardiovascular: ⬆DBP, ⬇SBP, compression of iliac and IVC, chest breathing now

• musculoskeletal: wide gait plus rectus abdominis splits ngl

• GI: acid reflux, maternal gut microbiome protects baby, pelvic discomfort

• neuro: carpal tunnel

maternal adaptation: preparing for birth

• baby got motion

• nesting

• lots of questions

sibling adaptation

• DONT FORCE INTERACTIONS

• have bonding time with baby and sibling

• give gift from infant to big sibling

• hug child first when you get home

frequency of visits in 3rd trimester

every 2 weeks, then weekly after 35 weeks if low risk

when is adacel (TDAP) given

27-32 weeks

when is rhogam given (date)

28 weeks

when is GBS (group b strep) done

35-37 weeks

precautions for GBS (group B)

• test before birth so can give antibiotics

• can do vaginal as long as u got the antibiotics

• dangerous if not treated, sepsis in baby

nutrition in 3rd trimester (how many extra cals)

452 extra cals per day

third trimester care past 40 weeks

• offer induction (IOL): 41+0 to 42+0 weeks

• antenatal testing 41-42 wks: NST, amniotic fluid vol

• risks: labour dystocia, severe perineal injury, chorioamniotits, PPH, C/S. abnormal fetal growth, oligiohydramnios, meconium, low APGAR, still birth

normal amt of fetal movements

greater than 6 in 2h

third trimester education

• birth plan

• admission

• feeding suppor

• newborn care

• maternity leave

• mental health

• follow up, contraception, pp care

hypertensive disorders of preg (6)

• nonsevere: SBP 140+ and DBP 90+

• severe: SBP 160+ and DBP 100+ (BAD)

• chronic hypertension: <20 weeks

• gestational hypertension (PIH): >20 weeks

• pre-eclampsia

• eclampsia

can gestational hypertension and hypertern tension develope pre-eclampsia/eclampsia

yes

management of gestational and chronic hypertension

• accurate and consistent BP

• deep tendon reflexes (biceps, patellar, ankle)

• fetal health surveillance: NST, BPP, US

• reduce activity and change diet

pre-eclampsia and what it condition leads to it

• chronic/gestational hypertension with new onset of proteinuria (protein in pee)

• organ dysfunc might be present

eclampsia

• seizures from cerebral effects of pre-clampsia

• before, during, after birth

proteinuria criteria

≥0.03g/L in 2 random urine collections 6h apart OR 0.3L in 24h collection

cause of pre-eclampsia (NOT HYPERTENSION)

abnormal placentation

can ppl with pre-eclampsia/eclampsia get preg again

yea but some risk

Hemolysis (H), Elevated Liver enzymes (EL), Low Platelets (LP) syndrome

• life threatening variant of severe pre-eclampsia (but high BP and proteinuria might not be present)

• S&S: malaise, N/V, epigastric or RUQ

• ¼ chance for death

• risk: old, yt, multiparous

• RBCs hemolyze getting stuck, endothelial dmg in liver causes necrosis, inc liver enzy

pre-eclampsia, eclampsia, and HELLP management

• severe: in patient

• assessment and monitoring: CNS, renal system, cardiovascular sys, liver enzy, CBC, platelets, coagulation profile, electrolytes

• MONITOR FHR in case of hypoxia from uteroplacental insufficiency

pre-eclampsia, eclampsia, and HELLP management: pharma (2 meds)

• corticosteriods: fetal lung maturation

• magnesium: prevention and treatment of seizures

• mg toxicity: loss of patellar reflexes, resp/muscular depression, oliguria, dec LOC

antidote for mg toxicity

calcium gluconate

eclampsia management

• seizure precautions

• low sensory env

• rapid assessments of cervical, uterine activity, and fetal status

• birth plan 

• prepare for chest x-ray and arterial blood gasses

pre-eclampsia, eclampsia, and HELLP management: post partum

• monitor and assessment

• check pre-eclampsia symptoms resolve after 48 hrs

• 72-96 hrs: lab abnormalities for HELLP resolve

• mg sulf cont for 24 hours for seizure precaution

• anti PPH meds: oxytocin and prostaglandins

pre-eclampsia, eclampsia, and HELLP management: future considerations for pregnancy

• inc risk for HDP in future but lower severity 

• inc risk for HTN later in life

gestational diabetes mellitus (GDM)

• inc risk of t2d in life after

• universal screening 24-28 weeks

gestational diabetes mellitus (GDM) risks to mom and baby

• maternal: ⬆ risk of developing pre-eclampsia, birth with shoulder dystocia, C/S, LGA (large for gestational age)

• fetal: hypoglycemia, intrauterine growth restriction, intrauterine fetal demise

gestational diabetes mellitus (GDM) nursing care

• antepartum (preg): BG control, diet, exercise, insulin

• intrapartum (labour): IOL at 38-40wk, insulin w. sliding scale, FHR monitoring

• post partum: OGTT 6 week test PP, BG typically returns to normal

BG control lvls

• fasting: 3.8-5.2

• 1hr PP: 5.5-7.7

• 2hr PP: 5-6

placenta previa

• placenta implants in lower uterine segment covering cervical os

• risk factors: previous Hx, C/S. cervical curettage, smoking, high altitude, multiple gestation, AMA, male fetuses, ethnicity

• NO VAG DELIVERY

placenta previa clincal manifestations

• painless and bright red bleeding 2/3 trimester

• vitals might be normal

• FHR normal unless major detachment

• soft, relaxed, non tender uterus

• high fundal hieght for gestation

placenta previa outcomes

• hemorrhage

• abnormal placental attachment (accreta, increta, percreta)

• hysterectomy

• C/S

• blood issues - infections and transfusions

• preterm birth, fetal anomalities

placenta previa is expectant

• reduce activity

• close observation

• US, NST, BPP

• corticosteriods

• pelvic rest

• potential for C/S

placenta previa is active so you do what

expectant management stopped as soon as bleeding