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Neagele's Rule. how to estipate the dutea date of delivery?
- Based on the date of last normal menstrual period with the assumption that the woman has a 28 day cycle.
- ex. LMD August 26 add 7 days = September 2nd
- September is 9th months - 3 = 6th month (June) EDD/EDC/EDB = June 2nd
what medicine is used in contined ectopic pregnancy in the fallopian tube?
Methotrexate - a chemotherapeutic drug and folic acid inhibitor that stops cell production and destroyes remaining trohpoblastic tissue. If mass is unraptureed and measures 1.6 in (4 cm)
miscariage that ends before 20 weeks gestation.
If you don't believe in abortion do you have the right to refuse to give care to those who came for an abortion?
Your responsibility as a nurse is to make sure she gets proper care that there is somebody to replace you but until then you must care for the patient.
- Complete previa: placenta covers the entire cervical os
- Partial: placenta that partially occludes the cervical os
- Marginal: encroachment of the placenta to the margin of the cerfical os.
- S/S: Painless vaginal bleeding(bright red).
- premature seperation of a normally implanted placenta from the uterine wall.
- S/S: bleeding with sever abdominal pain. Other - uterine tenderness and abdoimnal or bakc pain, a board-like abdomen and no vaginal bleeding, abnormal contractions and increased uterine tone, fetal compromise as evidenced b late fetal heart rate decelarations.
Premature Rupture of the placenta
- at any time of pregnancy
- S/S gush or leakage of fluid from the vagina.
- is that is present and observable before pregnancy or hypertension that is diagnosed before the 20th week of gestation.
- BP greater than 140/90
Preeclampsia and Eclmapsia
- Preeclampsia: increase in BP after 20 weeks' gestation accompained by proteinuria. (edema)
- Eclmapsia: occurence of a grand mal seizure (bol'shoi epilepticheskii pripadok) in a woman with preeclapsia who has no other cause for seizures.
- Prec: causes wide spread arteriolar vasoconstriction that affects the brain (seizure and stroke), kidneys (oliguria and renal failure), liver ( edema and subcapsular hematoma), small blood vesseles(small ruptures withing the walls of the vessels use up large amounts of platelets in an efort to correct the bleeding. This results in thrombocytopenia(low platelet count) and DIC.
- Treatment: magnesium sulfate - anticonvulsant in case of preeclampsia to prevent siezures (other uses, tocolytic to ripen the cervix).
whos BP elevation detected for the first time during pregnancy, without proteinuria. No proteinuria. BP falls into a normal range by 12 weeks postpartum.
- a serious complication of preeclampsia.
- Platelets counts decrease, Liver nezymes Increase.
- Hemolysis of RBC as they try to navigate through constricted vesseles. Vasospasms decrease blood flow to the liver, resutling in tissue ischemia and hemorrhagic necrosis (Elevated liver enzymes). In response to the endothelial damage caused by the vasospasms (small openings develop in the vessels), patelets aggregate at the site and a fibrin network is set up, leading to a decrease in the circulating platelets (Low platelets)
Disseminated intravascular coagulopathy (DIC)
is a hematological disorder characterized by a pathological form of clotting that is diffuse and consumes large amounts of clotting factors. DIC causes wide spread external or internal bleeding or both. Common cause in pregnangcy: are excessive blood loss with inadequate blood component replacement. Depletion of the platelets and clotting factors.
Different characteristics of multiple gestations
- Monozygotic: "identical twins", the product of one ovum that split around the end of the first week after fertilization.
- Dizogotic: "Fraternal twins" two separate ova have been fertilized by two sperm.
- Dichorionic/diamnionic: two chorinos and two amnions
- Monochorionic/diamnionic: One chorion and two amnions
- Monochorionic/monoamnionic: One chorion and one amnion - the fetuses share the same living quarters.
Singes of pregnancy?
- Presumptive signes of pregnancy: (Subjective) amenorrhea, nausea/vomiting, frequent urination, breast tenderness, fatique
- Probable signes of pregnancy: (objective) objerseved by the examiner. Physical changes in reproductive system. ex. abdominal enlargement, Goodell's sign (softening of the tip of the cervix), Chadwick's sign (bluish color of the vaginal mucosa and cervix), Braxton-Hicks sign ( intermittent uterine contractions), positive pregnancy test
- POsitive signs: attribute only to the presence of a fetus - Fetal heartbeat, Visualization of the fetus, Fetal movement palpated by the examiner.
- If mom Rh - and baby Rh +, mom gets RhoGam.
- Prevents production of anti Rh(D) antibodies in Rh negative patients who were exposed to Rh positive blood by suppresing the immune reaction and prevents hymolytic disease of the newborn in future pregnancies
- Route: IM, deltoid
- Dose: 300 mcg IM at 28 weeks and within 72 hr of delivery
- If mother is blood group O and the baby is ither A or B. Blood O carries no antigens but have anti A and anti B antibodies that can cross the placenta of a baby type blood A or B and cause hemolysis of the fetal RBCs
- Direct Coombs test: perforemd on baby's cord blood obtained at the time of birth. it Identifies presence of maternal antibodies in the neonante's blood and hymolysis or lysis of RBCs.
- Indirect Coombs: detects antibodies against RBCs in the maternal serum.
- Primary method of fetal survalance.
- Lie on her side and count the number of times the number of times that she feels the fetus move.
- Get at least 10 distinct movements in a period of up to 2 hours. Once 10 movements have been, percieved, the count may be discontinues.
Fetal Biophisical profile
- noninvasive "fetal physical examination" the most accurate in predicting fetal well-being than any singe assessment.
- consists of the folowwing and based on 30 minute time period
- Nonstress test: use of EFM for 20 min. Based on the condition that a normla fetus moves at various intervansl and that the CNS and myocardium responds to movement. Response demonstarated by acceleration of the FHr 15bpm lasting for 15 sec. Loss of heart rate reactivity is associated with a fetal sleep cycle.
- Contraction stress test: evaluates the FHR response to uterine contractins. fetal oxygen is transiently worsened by uterine contractions only. Evaluated according to the presence or absence of late FHR decelarations. Normal - no late decelarations.
two or more genes act together. A combination of genetic and environmental factors. Ex. cleft lip and palate, neural tube defects, pyloric stenosis, congenital heart dieseas depending on the number of genes for the particular defect and theamount of the environmental influence.
Grwoth and development of fetal periods
- starts at 9 weeks gestation
- 9-12 weeks: face become recognizable, head growth does not keep pace with body growthand slows by the twlfth week. Ossification centers appear, intestines heave the umbilical cord, external genitalia differentiate and are distinguishble by eek 12. LIver site fore red blood cells but at 12 spleen take cover. Urine production.
- 13-16: rapid growth. coordinated movements. bones becomes clearly visible, ovaries are differentiated, genitalia recognizable, primordial ovarian follicles are present by 16 weeks.
- 17-20: growth slows. Fetal movements felts, Skin covered with vernix, hair apears, lanugo, brown fat, uterus is formed by 18 weeks, testesbegun to descened, weighs 300 grams and 7.3 (19 cm)long.
- 21-25: gain much weight, skin pink and red, rapid eye movement, fingernails, lungs begun to secret serfuctant.
- 26-29: fetus may survive, lungs can breath air, eyelids open, bone marrow take over to make RBCs at 28 weeks.
- 30-34: pupilary light reflex
- 35-40: strong hand graps reflex andorientation to light
- group of agents that can infect the fetus or newborn.
- T: Taxoplasmosis - parasite in row or undecooked meat, in cat litter.
- O: Other infections - usually Hepatitis B virus
- R: Rubella virus - birth defect such as hearing loss, eye defects heart defects, mental retardation
- C: Cytomegalovirus - is a member of herpes virus family, healthy people have no symptoms. Mischariage, fetal intrauterine growth restriction, microphthalmia, chorioretinitits, blindness, microcephaly, cerebral calcification, mental retardation, deafness, cerebral palsy, hepatosplenomegaly.
- H: Herpes simplex virus - miscariage in early pregnancy. prematurity,dermatological scarring, hydrecephaly, encephalitis.
Maternal age and chromosomes
- age 35 and above is associated with an increased risk of chromosomal abnormalities.
- Trisomy 21 (down syndrome)
- startgin at 12 weeks for analyzing chromosomal abnormalities, fetal lung maturity, infection, presence of bilirubinin Rh - sensitized pregnancies, hydrominos.
- Compications: rupture membrances, preterm labor, infection, fetal injury, fetal death.
150 mg medroxyprogesterone shot every 3 months.
Subdermal hormonal implant - Implanon
effectvie for 3 years. the single-rod implant, inner side of the woman's upper arm
Gravida and parity
- Gravid is the state of being pregnant; a gravida is a pregnant woman. gravidity relates to the number of times that a woman has been pregnant, irrespective of the outcome.
- Parity: refers to the number of pregnancies carried to a point of viability(as 24 weeks of gestation) not the umber of fetus/babies and dosn't metter of alive or stillbirth.
- in male disuria and penie discharege. Women asymptomatic. May include abnormal vaginal discharge, irregular menses, postcoital bleeding low backacke, urinary frequncy and dysuria.