concise unit 2 ob

Genotype

Genetic makeup of an individual

Phenotype

Outward expression of genes

High Risk Genetics

Age >35, family history, teratogens, previous anomalies

Common Teratogens

Alcohol, ACE inhibitors, cocaine, warfarin, CMV, rubella, toxoplasmosis, zika

Organogenesis

Completed by week 8; highest teratogenic risk

Fetal Heartbeat Detectable

6 weeks ultrasound, 10-12 weeks Doppler

Carrier Testing

Identifies risk of inherited genetic disorders

Preimplantation Testing

Done before embryo transfer during IVF

Placenta Function

Gas exchange, nutrients, hormones progesterone estrogen hCG hPL

Amniotic Fluid

Protects fetus, maintains temperature, cushions, allows movement

Umbilical Cord

1 vein oxygenated, 2 arteries deoxygenated, Whartons jelly prevents compression

Whartons Jelly

Protective substance around umbilical vessels

Umbilical Arteries

Carry deoxygenated blood away from fetus

Umbilical Vein

Carries oxygenated blood to fetus

Ductus Venosus

Shunts blood from umbilical vein to inferior vena cava

Foramen Ovale

Shunts blood between fetal atria, closes after birth

Ductus Arteriosus

Shunts blood from pulmonary artery to aorta, closes after birth

Presumptive Signs

Subjective: amenorrhea, fatigue, nausea, quickening

Probable Signs

Objective: positive hCG, Chadwicks sign, Goodells sign

Positive Signs

Fetal heart tones, ultrasound, palpated fetal movement

Naegeles Rule

EDD = LMP +7 days -3 months +1 year

First Trimester

Weeks 0-13: organogenesis, fatigue, nausea, breast tenderness

Second Trimester

Weeks 14-27: quickening, anatomy scan, stable mood

Third Trimester

Weeks 28-40: weight gain, SOB, edema, Braxton Hicks

Supine Hypotension

Caused by vena cava compression; reposition left lateral

Kick Counts

Begin 28 weeks; expect 10 movements in 2 hours

Key Prenatal Labs

CBC, Rh, HIV, RPR, Hep B, Rubella, glucose, GBS

Gestational Diabetes Screen

24-28 weeks; 1-hour glucose challenge test

Group B Strep Testing

35-37 weeks; IV penicillin if positive

Quad Screen

15-20 weeks; tests for genetic anomalies

GBS Positive Care

Give IV penicillin during labor

Estimated Fetal Weight

Measured by fundal height; weeks roughly equals cm between 18-30

EDD Calculation

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

Danger Signs First Trimester

Bleeding, severe cramping, hyperemesis, fever

Danger Signs Second Trimester

No fetal movement, bleeding, pelvic pain

Danger Signs Third Trimester

Severe headache, vision changes, RUQ pain, bleeding

Preeclampsia Signs

BP >140/90, proteinuria, headache, visual changes, RUQ pain

Severe Preeclampsia

BP >160/110, oliguria, hyperreflexia, headache

Eclampsia

Preeclampsia + seizures

HELLP Syndrome

Hemolysis, Elevated Liver Enzymes, Low Platelets

Placenta Previa

Painless bright bleeding, soft uterus, avoid vaginal exams

Placental Abruption

Painful dark bleeding, rigid uterus, abnormal FHR

Hyperemesis Gravidarum

Severe vomiting, dehydration, weight loss, ketonuria

Hydatidiform Mole

Abnormal growth of placental tissue, positive hCG, no heartbeat

Rh Incompatibility

Rh- mom with Rh+ baby; give RhoGAM at 28 weeks and postpartum if needed

Magnesium Sulfate

Prevents seizures in preeclampsia; monitor for toxicity

Magnesium Toxicity Signs

Low reflexes, RR<12, UOP<30mL/hr; antidote calcium gluconate

Calcium Gluconate

Reverses magnesium toxicity

Oxytocin Use

Induces labor; stop if tachysystole or late decels

Betamethasone

Given 24-34 weeks to promote fetal lung maturity

Terbutaline

Tocolytic; delays preterm labor; monitor maternal tachycardia

RhoGAM

Prevents maternal sensitization in Rh- mothers

IV Penicillin

Given to GBS-positive clients during labor

Folic Acid Supplement

Prevents neural tube defects; start preconception

Late Decelerations

Placental insufficiency; reposition, oxygen, fluids, notify provider

Variable Decelerations

Cord compression; reposition client

Early Decelerations

Head compression; normal finding

Normal FHR

110-160 bpm

Minimal Variability

Can indicate hypoxia or sleep; monitor closely

Absent Variability

Non-reassuring, possible fetal compromise

Accelerations

Increase in FHR greater than or equal to 15 bpm for greater than or equal to 15 sec; reassuring

Psychosocial First Trimester

Ambivalence, anxiety, mixed emotions

Psychosocial Second Trimester

Acceptance, bonding, better mood

Psychosocial Third Trimester

Impatience, labor anxiety, body image issues

Cultural Competence

Knowing patient beliefs and customs

Cultural Humility

Respecting preferences; adapting care

Trauma Informed Care

Ask permission, explain procedures, give choices