Week 1- Caring of the Woman during Pregnancy and during the Postpartal Period

CH 1, 2, 3 (95-107), 10 (323-330), 11, 12, 15, 16, 21 (800-802), and 22

What is the modern beliefs about childbirth (in relation to historical beliefs)?

return of midwives and doulas; childbirth choices based on what works best for mother, child and family

What is the current practice for maternal and newborn nursing? (4)

• complex with increased technology (ex. IVF, 22 week for survival)

• Threats of litigation (lawsuits)

• Care under time

• Economic restraints

what is mortality?

number of people who have died over a specific period

What is the maternal mortality rate? (Definition!)

annual number of deaths from any cause during pregnancy or within 42 days of termination per every 100,000 live births

What race/ethnicity has the highest maternal mortality rate?

African American women

how is the US’s ranking in terms of maternal mortality rate?

Not great based on how technologically advanced medicine is —> ranked 46th

what is the fetal mortality rate? (Definition)

Number of fetal deaths (20 weeks or older) per 1,000 live births

Note: it is a major but often overlooked health problem

what are some maternal factors to the fetal mortality rate? (4)

• malnutrition

• Disease

• Preterm cervical dilation

• Comorbidities- ex. gestational or pre-existing diabetes, HTN, etc.

What are some fetal factors to the fetal mortality rate? (2)

• chromosomal abnormalities

• Poor placental attachment

What is the neonatal mortality rate? (Definition)

number of infant deaths (in the first 28 days) per 1,000 live births

what is the infant mortality rate? (Definition)

number of infant deaths (in the first 12 months) per every 1,000 births

What are some causes of infant mortality? (2)

• congenital anomalies = leading cause

• Low birth weight and prematurity = significant predictors of infant mortality

What are some causes of low birth weight and prematurity in babies?(4)

• alcohol

• smoking

• Malnutrition

• Comorbidities —> HTN/DM

what are some factors that can impact maternal and child health? (8)

• family- medical history!! ← especially maternal side!! Can predict complications

• Genetics

• Society

• Global society

• Culture- new environments ← for us its the ORs/delivery suites ← can cause a shock

• Health status and lifestyle

• Access to healthcare- distance?, $, options?

• Improvement to diagnosis and treatments

How does someone’s culture impact their experiences in maternal and child health? (3)

• immigration = new environment

• Spirituality and religion

• Changing cultural dynamics due to differing population distributions

How does someone’s health status and lifestyle impact their experiences with maternal and child health?

• developmental level- 15 yr old vs. 30 yr old vs. 45 yr old having baby

• Nutrition- deficient or excess (obesity)

• Lifestyle choices- eating patterns, exercise, tobacco/drugs/alcohol, coping mechanisms, level of stress

• Environment- exposure to teratogens, pollution, water/food contamination

• Stress and coping- disasters, crises, $$, support systems, violence

what are teratogens and when are they the most problematic?

• def = any substance, organism, physical agent, or deficiency state present during gestation that is capable of inducing abnormal postnatal structure or function by interfering with normal embryonic and fetal development AKA anything that can harm the baby during development

• Most problematic in beginning of pregnancy when initial development of body systems is taking place

What are some examples of legal and ethical issues in maternal and child health care? (8)

• abortion

• Substance abuse - criminal implications for mom?

• Intrauterine therapy- medical technology advancements (ex. In-utero micro surgeries) vs nature

• Maternal- fetal conflict - who to save? Beneficence and autonomy?

• stem cell research and use of embryonic stem cells for medical advancement

• Umbilical cord blood banking

• Informed consent when mother is a minor

• refusal of medical treatments vs parental consent ← more of a problem in peds

What is atraumatic care? how can we help to provide it? (3)

Delivery of care that minimizes or eliminates psychological and physical distress experienced by children and families in the health care system

1. Preventing/minimizing physical stressors

2. Preventing/minimizing separation

3. Promoting a sense of control

what is unique about maternal and child health as compared to previous semesters?

family centered care vs patient centered care

More focused on meeting needs of patient and family as they can help to support the patient best

What is discharge planning?

development and implementation of a comprehensive plan from safe discharge from a facility and for continuing safe and effective care in the community and at home

what is case management?

Coordinating health care services while balancing quality and cost outcomes

What is the function of the external female reproductive organs? (2) What is it called?

AKA vulva

1. Protects urethra and vaginal openings

2. Highly sensitive to touch to increase female’s pleasure during sexual arousal

What are the components of the vulva? Functions? (6)

1. Mons pubis- fatty tissue to protect the pubic symphysis

2. Labia majora- contains sweat and sebaceous glands and protects vaginal opening

3. labia minora- highly vascular and abundant nerve supply; lubricates vulva and swells with stimulation

4. Clitoris- small cylindrical mass of erectile tissue and serves; function = sexual stimulation

5. Vestibular structures- urethra, vagina, 2 sets of glands (secrete mucus to keep opening moist)

6. Perineum = vagina ←> anus

what are the internal female reproductive organs? Functions? (5)

1. Vagina- pathway to external environment from uterus

2. Uterus- home to fetus

3. Cervix- opening to uterus (note: should be closed until labor begins)

4. Fallopian tubes- connect the uterus to the ovaries

5. Ovaries- produce eggs

What are the layers of the uterine wall? (3)

1. Endometrium- lines the uterine cavity in nonpregnant women

2. Myometrium- majority of uterus- contracts during labor

3. Perimetrium- covers body of the uterus

What is menstruation?

expulsion of inner uterine lining occurring monthly

Marks the beginning and end of each menstrual cycle

what is menarche?

establishment of menstruation in females; occurs around 12-14 yrs old

what is menopause?

naturally occurring cessation of regular menstrual cycles

what is the frequency of menstruation?

21-36 days ← variable

what are the 3 stages of the ovarian cycle? Timeline?

1. Follicular phase = day 1 through ovulation (days 10-14)

2. Ovulation = day 14 of a 28 day cycle

3. Luteal phase = day 15 through 28 of a 28 day cycle

What are the 4 phases of the uterine cycle?

1. Menstrual

2. Proliferative

3. Secretory

4. Ischemic

What happens during the follicular phase? (Hormones! -2)

1. FSH stimulates follicle development

2. Estrogen rises → endometrial proliferation

What happens during ovulation? (2)

1. LH surges to trigger the release of the ovum

2. Cervical mucus becomes thin and stretchy

What happens during the luteal phase? (3 → hint include the outcome when fertilization occurs and when it doesn’t)

1. Corpus luteum secretes progesterone

2. Prepares endometrium for implantation

   If no fertilization the corpus luteum regresses → progesterone decreases → menstruation occurs

What is the role of GnRH (gonadotropin releasing hormone)?

stimulates the release of FSH and LH from the anterior pituitary

What is the role of FSH? (2)

1. Follicle growth

2. Estrogen secretion

What is the role of LH? (2)

1. Ovulation

2. Forms corpus luteum

What is the role of estrogen? (2)

1. Develops endometrium

2. Secondary sex characteristics - breast development, fat distribution

What is the role of progesterone? (2)

1. Maintains uterine lining

2. Relaxes uterine muscle - prevents contractions

What is the role of prostaglandins? (2)

1. Influence ovulation

2. Cause uterine contractions and cramps

When are LH levels at their highest during the menstrual cycle?

Ovulation

When are FSH levels at their highest during the menstrual cycle?

During the first week of the follicular phase

When are estrogen levels at their highest during the menstrual cycle?

just before ovulation

When are progesterone levels at their highest during the menstrual cycle?

5-7 days after ovulation during the luteal phase

What are the stages of fetal development? (4)

1. Zygotic stage

2. Blastocyst stage

3. Embryonic stage

4. Fetal stage

What occurs during the zygotic stage?

Fertilization of sperm and egg AKA conception

what occurs during the embryonic stage of development?

Basic structures of major body organs and main external features

what occurs during the fetal stage?

differentiation and structures specialize

When is the embryonic stage of development?

end of 2nd week through the 8th week

When is the fetal stage of development?

End of 8th week until birth

What does the placenta do for the fetus? (3)

1. Protection from mother’s immune system

2. Removing waste products from the fetus

3. Inducing mother to bring more food to the placenta to ensure the fetus is supplied with nutrients and oxygen

what are the components of the umbilical cord? (3)

1. One large vein

2. 2 small arteries

3. Wharton jelly that surrounds the vessels to prevent compression

What are the roles of the amniotic fluid? (5)

1. Helps maintain constant body temp for fetus

2. Permits symmetrical growth and development

3. Protects/cushions fetus from trauma

4. Allows umbilical cord to be relatively free of compression

5. Promotes fetal movement to enhance the development of the musculoskeletal systems

What is the risk associated with too LITTLE amniotic fluid?

can compress umbilical cord

What is the risk associated with too MUCH amniotic fluid?

Can increase risk of cord wrapping around baby neck

What is pharmacogenomics?

study of genetic and genomic influences on pharmacodynamics and pharmacotherapeutics

Includes testing for genetic disorders and gene therapy

IDEALLY when should new parents receive genetic evaluations and counseling?

before conception

What is the following sign of pregnancy?

Fatigue (12 weeks)

Presumptive

What is the following sign of pregnancy?

Breast tenderness (3-4 weeks)

Presumptive

What is the following sign of pregnancy?

N/V (4-14 weeks)

presumptive

What is the following sign of pregnancy?

Amenorrhea (4 weeks)

Presumptive

Note- it is the absence of menstrual cycle

What is the following sign of pregnancy?

Urinary frequency (6-12 weeks)

presumptive

What is the following sign of pregnancy?

Hyperpigmentation of skin (16 weeks)

Presumptive

What is quickening?

fetal movements

What is the following sign of pregnancy?

Quickening (16-20 weeks)

presumptive

What is the following sign of pregnancy?

Uterine enlargement (7-12 weeks)

presumptive

What is the following sign of pregnancy?

Breast enlargement (6 weeks)

presumptive

What is the following sign of pregnancy?

Braxton Hicks contractions (16-28 weeks)

probable

What is the following sign of pregnancy?

Positive pregnancy test (4-12 weeks)

probable

Note: HcG can also indicate cancer

What is the following sign of pregnancy?

Abdominal enlargement (14 weeks)

probable

What is the following sign of pregnancy?

Ballotment (16-28 weeks)

Probable

What is ballotment?

gently pushing on the uterus through the abdominal wall or vagina to displace the fetus. If the fetus is present, it will rebound and tap against the examiner's fingers

What is the following sign of pregnancy?

Goodell sign (5 weeks)

probable

What is the following sign of pregnancy?

Chadwick sign (6-8 weeks)

probable

What is the following sign of pregnancy?

Hegar sign (6-12 weeks)

probable

What is the following sign of pregnancy?

Ultrasound verification of embryo or fetus (4-6 weeks)

positive

What is the following sign of pregnancy?

Fetal movement felt by experienced clinician (NOT THE PT) (20 weeks)

positive

What is the following sign of pregnancy?

Auscultation of fetal heart tones via doppler (10-12 weeks)

positive

what is a presumptive sign of pregnancy?

subjective feelings a women feels that can occur during pregnancy but can also occur without a pregnancy

what is a probable sign of pregnancy?

Objective signs of a pregnancy that can be measured by others or proven to others but can also occur without a pregnancy

what is a positive sign of pregnancy?

Signs of pregnancy that are observed by trained professionals that are able to prove that a pregnancy is taking place

What is Chadwick’s sign?

bluish-purple discoloration of the cervix, vagina and vulva

What causes Chadwick’s sign? (2)

• increased vascularity

• congestion of pelvic blood due to rising estrogen levels

What is goodell’s sign?

softening of the cervix from firm (tip of nose) to soft (earlobe consistency)

What causes goodell’s sign? (3)

• increased vascularization

• Edema

• Hyperplasia of cervical tissues

• Under influence of estrogen and progesterone

what is hegar’s sign?

softening and compressibility of the lower uterine segment (isthmus) just above the cervix

what is the cause of hegar’s sign?

hormonal (estrogen and progesterone) effects cause relaxation of uterine muscles and increased blood supply

How do you measure fundal height?

measuring from where the fundus is palpated to the pubic symphysis

when is fundal height a reliable determination of gestational age until?

36 weeks

what is ripening of the cervix?

softening and thinning

What is leukorrhea?

Vaginal secretions that are more acidic, white, and thicker than usual

Does ovulation continue during pregnancy?

No

what is colostrum?

Antibody-rich, yellow fluid that can be expressed after the 12th week; the conversion to more mature milk about 3 days after delivery

What is ptyalism?

Excess spit AKA excessive salivation

what happens to the blood supply during pregnancy? What can this cause? (2)

A 50% increase in pre pregnancy levels of blood volume and cardiac output increases

1. Can cause underlying cardiac issues to surface

2. Hypercoaguable states due to increased blood clotting components

What is the mask of pregnancy or facial melasma?

Sun spots

what is Linea nigra?

Brown line through belly to pubic symphysis

what is striae grivadarum?

stretch marks

What are the nutritional needs of pregnancy? (3 but 1 of the 3 has 4 parts)

1. Vitamin and mineral supplements daily

2. Increase in…

   1. Protein

   2. Iron

   3. Folate

   4. Calories

3. Avoidance of some fish due to mercury content