Unit 3 and 4 OB

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  1. When does the antepartal period begin?
    From 1st day LMP until beginning of true labor
  2. How long is pregnancy?
    280 days=40 weeks=9 calendar months
  3. Antepartal care schedule
    • Every 4 weeks until 28 weeks
    • Every 2 weeks until 36 weeks
    • Weekly until delivery
  4. Nagele's Rule
    1st day of LMP - 3 months + 7 days
  5. How do you establish ECD from ultrasound?
    Measure CR (crown-rump) length
  6. At what age gestation is the CR measurement most accurate?
    7-13 weeks
  7. How is EDC determined using biparietal diameter?
    After 13 weeks gestation, but before midpoint in pregnancy, measure the woman's belly
  8. What is considered a term baby?
    38-42 weeks
  9. What is a preterm baby?
    20-37 completed weeks
  10. What is considered an abortion?
    Any pregnancy that ended prior to 20 weeks gestation
  11. What is considered a Living pregnancy?
    Alive TODAY (not just born alive)
  12. If a woman is Primigravida and has not delivered yet, how is that shown?
    G1 P0000
  13. Primigravida, after term delivery is shown?
    G1 P1000
  14. Primigravida, baby died of SIDS is shown how?
    G1 P1000
  15. If a woman has been pregnant 3 times, delivered twice at term, those children are alive today and had one spontaneous abortion at 5 weeks gestation.  How is this shown?
    G3 P2012
  16. G3 P2012, pregnant again
    G4 P2012
  17. G4 P2012 woman who delivered her new baby at term and it's alive today?
    G4 P3013
  18. Primigravida, pregnant with twins
    G1 P0000
  19. G1 P0000 (woman pregnant with twins) delivers at 36 weeks gestation and the babies are alive today
    G1 P0102
  20. G1 P0102 (woman who had twins and both are living today) gets pregnant again with a single fetus
    G2 P0102
  21. G2 P0102 (woman who had delivered twins and got pregnant again) delivers the new baby at term and is alive today
    G2 P1103
  22. Primigravida, pregnant with twins
    G1 P0000
  23. G1 P0000 (woman pregnant with twins), delivers at term and babies are alive
    G1 P1002
  24. Primigravida, pregnant with twins, delivers at term, one dies
    G1 P1001
  25. 2000: 38 weeks, living and well
    2002: 27 weeks, living and well
    2004: twins, 34 weeks, living and well
    2006: ectopic pregnancy, 13 weeks
    2008: triplets, 32 weeks, one died of SIDS
    2010: 41 weeks, living and well

    What is her gravidity and parity according to TPAL?
    G6 P2317
  26. Which routine lab test is run for all pregnant women?
    Urinalysis and C&S
  27. What does estrogen do in pregnancy?
    It stimulates
  28. What happens to heart rate in pregnancy?
    Increases 10-15 BPM
  29. What happens to blood volume in pregnancy?
    Increases 30-50%
  30. What happens to the cardiac stroke volume in pregnancy?
    It increases with every systole
  31. What happens to cardiac output in pregnancy?
    It increases about 40%
  32. What does progesterone do in pregnancy?
    It relaxes blood vessel walls
  33. If a pregnant woman's diastolic blood pressure is greater than 80, what does this indicate?
    That her blood pressure is actually high and is only appearing low b/c of the progesterone relaxing the vessel walls
  34. Why does the risk of blood clots increase in pregnancy?
    Fibrin, fibrinogen and clotting factors rise
  35. What does progesterone do to respirations in pregnancy?
    Causes the respiratory center in the brain to be more sensitive to CO2 b/c more O2 is needed for fetus, placenta etc.
  36. What does elevated progesterone do to the GI tract in pregnancy?
    Decreased gastric activity; stomach has less peristalsis and tone b/c progesterone RELAXES
  37. What causes heartburn in pregnancy?
    Decreased sphincter tone = reflux of stomach acid
  38. What changes does progesterone cause in the urinary system during pregnancy?
    Dilates renal pelves and ureters and causes slowed peristalsis
  39. What causes a rise in GFR?
    Blood flow to kidneys is increased and kidneys filter more plasma
  40. What causes "spider angiomas" or dilated skin arterioles?
    Elevated estrogen levels
  41. What integumentary changes does estrogen cause?
    Darkening of nevi, palmar erythema, boggy mucosa
  42. Estrogen and progesterone balances cause what types of integumentary changes?
    Areolas darken, linea alba becomes linea nigra, cholasma "mask of pregnancy"
  43. What is responsible for striae and why?
    Estrogen, b/c it softens the fibrous tissues
  44. What is the separation of the abdominal muscles called?
    Diastasis rectus
  45. What does oxytocin do?
    Promotes uterine contractility
  46. What is responsible for the thyroid gland enlarging in pregnancy?
  47. What causes the adrenal gland cortex to enlarge?
  48. Which hormone plays the greatest role in maintaining pregnancy?
  49. What does progesterone do (besides relax)?
    Maintains endometrium and stops uterine contractility
  50. What medication is given to decrease preterm  birth?
  51. What is HPL (human placental lactogen) responsible for?
    Fights against insulin, increases amount of free fatty acids, decreases maternal metabolism of glucose
  52. What is Relaxin responsible for?
    Inhibits uterine contractility, decreases strength of contractions, softens cervix
  53. What causes the uterine myometrial cells to enlarge?
  54. How much of the maternal blood volume is within the uterine vascular system by EDC?
  55. What is Hegar's sign?
    softening of the uterine isthmus
  56. What does Hegar's sign allow?
    McDonald's sign
  57. What is McDonald's sign?
    Ease of flexion of the uterine body against cervix
  58. When is the fundal height palpable above the pubic synthesis?
    12 weeks
  59. When is the fundal height midway between pubic bone and umbilicus?
    16 weeks
  60. When is the fundal height at the umbilicus?
    20 weeks
  61. At what point during the pregnancy should the EDC be re-visited and verified?
    midway (20 weeks)
  62. What is quickening?
    The baby is moving on a daily basis
  63. How is the McDonald Method performed?
    Measure just above the pubic synthesis to the fundus
  64. How are the findings of the McDonald Method interpreted?
    # of cm = # of weeks +/- 2 weeks
  65. Which Rh factor is bad for baby?
  66. What is erythroblastosis fetalis?
    Abnormal condition of RBC; fetus becomes anemic and gets heart failure
  67. What causes hyperbilirubinemia?
    ABO incompatability d/t O having antibodies to A & B type
  68. What is MSAFP (maternal serum alpha fetoprotein), when is it done and what does it indicate?
    Optional screening test done 15-20 weeks, high amounts indicate neural tube defects
  69. When is Down Syndrome screening done and in which ways?
    • Bloodwork at 9-13 weeks
    • Ultrasound 11-14 weeks shows collection at the base of baby's neck
  70. When is serum glucose test performed?
    24-28 weeks gestation
  71. When is GBS (group B strep) checked, how and why?
    35-37 weeks gestation, vaginal/urine culture, b/c it can give babies meningitis/pneumonia
  72. When is chorionic villus sampling done? When are the results come back?
    10-13 weeks, results 1-2 weeks
  73. When is an amniocentesis done?
    14-20 weeks, rarely as early as 11; results can take up to 4 weeks
  74. Where is intimate partner violence often seen  on pregnant women?
    breasts, belly, and genitals
  75. When pregnant women exercise, what do they need to be encouraged to do and why?
    Drink plenty of fluids to decrease becoming dehydrated and causing preterm labor
  76. Why should women be careful when exercising during pregnancy?
    Joints are lax, center of gravity changes, increased risk of falls/injury
  77. When pregnant women take road trips, how often should they take breaks?
    Every 100 miles for 10 minutes, no more than 5-6 hours and they should always have snacks
  78. Obese patients have increased risk of?
    Hypertension, gestational diabetes, induced labor, C/S
  79. Underweight patients run the risk of?
    Premature delivery, low birth weight, intrauterine growth restriction
  80. How much weight should a woman with BMI <18.5 gain during pregnancy?
    28-40 lbs
  81. How much weight should a woman with BMI of 18.5-24.9 gain during pregnancy?
    25-35 lbs
  82. How much weight should a woman with BMI of 25-29.9 gain during pregnancy?
    15-25 lbs
  83. How much weight should a woman with BMI 30 and > gain during pregnancy?
    11-20 lbs
  84. Pattern of weight gain during pregnancy?
    1.1-4.4 lbs total 1st trimester, then slightly < 1lb/wk
  85. How much do calorie needs increase in pregnancy?
    About 300 cal/day
  86. How much water is needed during pregnancy?
    1 liter per 1000 calories consumed
  87. RDA recommendation of protein for pregnant women?
    70 g/day
  88. RDA recommendation for milk consumption (for protein) in pregnancy?
    1 qt/day
  89. RDA recommendation for iron requirement in pregnancy?
    30 mg/day
  90. Which foods are rich in iron?
    Red meat, whole grains, dark green leafy vegetables
  91. What causes the uterus to decrease in size?
    Uterine contractions, autolysis
  92. What endometrial changes occur postpartum?
    Uterine contractions decrease placental site to 1/2 predelivery size and Blood loss is controlled
  93. How long does it take for placental and decidual necrosis/regeneration to occur?
    6 weeks (3 wks placenta 3 wks decidua)
  94. How long should lochia rubra last and what is it composed of?
    2-3 days, composed of blood, mucus, decidual particles and cellular debris from placental site
  95. When should lochia serosa start and what does it look like?
    at 3-4 days; less oozing blood, more watery (serous); pinkish tan color
  96. What does lochia alba look like, when does it disappear?
    Yellowish white to white in color; gone by 3rd PP week or a brownish mucoid discharge for a few days
  97. What is a scant measure of lochia?
  98. What is a light amount of lochia?
  99. What is a moderate measure of lochia?
  100. What is a heavy measure of lochia?
    Saturated peri pad
  101. When would an early PPH (postpartum hemorrhage) occur and what is the most common reason for it?
    Within first 24 hours, #1 reason is uterine atony
  102. When does late PPH (postpartum hemorrhage) occur and why?
    After 24 hours, due to retained placenta
  103. Where should the fundal height be postpartum?
    At umbilicus
  104. How much should fundal height decrease and at what rate?
    1 fingerbreadth per day
  105. How long postpartum should the fundus no longer be palpable in the abdomen?
    10 days PP
  106. How should fundus feel postpartum?
    Firm, in the midline
  107. Uterine atony causes_______?
    A boggy uterus
  108. What intervention should you do if you feel a boggy uterus?
    Massage and reassess
  109. How should you massage a uterus?
    Support base with one hand, massage fundus straight down towards patient's spine
  110. What should you take note of when massaging a uterus?
    Passage of clots, retained placenta, pieces of amniotic sac
  111. What size clot is too big?
    Any larger than a 1/2 dollar
  112. What should you do if the fundus is palpable on the right side of the abdomen?
    Have patient empty bladder and reassess
  113. How is oxytocin administered postpartum?
    10 units (1ml) IM via vastus lateralis or directly into the myometrium if C/S patient
  114. What is the major side effect of Methergine (methylergonovine)?
    Increased blood pressure
  115. When is bimanual compression utilized?
    For severe cases of uterine atony
  116. How is bimanual compression performed?
    One hand in the vagina, the other on the abdomen compressing the uterus
  117. What is the Bakri Tamponade Balloon used for?
    Putting pressure on the placental site
  118. What contributes to problems maintaining contractions postpartum?
    Uterus overdistended (multiples), clots or retained placenta, use of pitocin during labor
  119. What is a 1st degree laceration?
    Perineal skin and subcutaneous layer
  120. What is a 2nd degree laceration?
    Perineal skin, subcutaneous layer and perineal muscles
  121. What is a 3rd degree laceration?
    Perineal skin, sub-q layer, perineal muscles and rectal sphincter
  122. What is a 4th degree laceration?
    Perineal skin, sub-q layer, perineal muscles, rectal sphincter, rectal mucosa
  123. Episiotomies are always cut to which degree?
  124. Lacerations usually tear to which degrees?
    1st or 2nd
  125. 2 types of episiotomies
    Midline and mediolateral
  126. Intervention for episiotomy in the 1st 24 hours
    Ice packs- on for 20min/off for 20 min
  127. Intervention for episiotomies after 24 hours
    Sitz bath for 10 min bid
  128. Special considerations for 3rd and 4th degree lacerations
    • Nothing per rectum
    • Edema
    • Bruising
    • Emphasize increased fluids
    • Encourage ambulation
    • Stool softeners
  129. What should you do if you see a hematoma near episiotomy?
    Put ice on it and check q10min. If it gets bigger, call MD
  130. When does initial ovulation occur in bottlefeeding or breastfeeding women <28 days postpartum?
    10 weeks
  131. What is associated with delayed ovulation?
    Decreased estrogen levels
  132. How many cycles are usually anovulatory?
    First 1-2
  133. What constitutes a morbid temperature?
    38 degrees C (100.4 F) or greater, after the first 24 hours PP on any 2 consecutive days out of the first 10 days PP
  134. What is a tell tale symptom of endometritis?
    Foul smelling lochia
  135. What is the cause of tender, engorged, erythematous breast accompanied by malaise?
  136. When a woman has mastitis, what is the best  way to treat the engorgement?
    Feed/empty the breast q3h
  137. When does cardiac output return to normal after pregnancy?
    3 weeks
  138. What does the anterior pituitary secrete?
  139. What does prolactin do?
    initiates lactation
  140. What does the posterior pituitary secrete?
  141. What does oxytocin stimulate in breast feeding women?
    Milk let down
  142. How long is the "Taking in" period?
    1-2 days
  143. What occurs in the "taking in" period?
    • physically identify newborn
    • relate actions/characteristics of newborn
    • touch-fingertips, palms, embrace
  144. How long is the "Taking Hold" period?
    2-14 days
  145. What goes on during the "taking hold" period?
    • Concerns with ability to parent successfully
    • Strives to master infant care skills
    • Sensitive to feelings of inadequacy
    • Focus on regaining control of her body
  146. When does the "Letting Go" period start?
    15+ days
  147. What occurs in the "letting go" phase?
    • Family reorganization
    • Adaptation to newborn's dependency
  148. Which period is postpartum depression most likely to occur in?
    Letting go phase
  149. How does bonding occur?
    From parent to the infant
  150. How does attachment occur?
    Tie from the infant to the parent
  151. H/H levels indicating iron deficiency anemia
    Hct 32%, Hgb 11g/dl
  152. Treatment for iron deficiency anemia
    200 mg elemental iron
  153. What should iron be taken with?
    Vitamin C source
  154. RDA recommendation for folic acid?
    600 mcg/day
  155. Folic acid deficiency is linked to?
    Neural tube defects
  156. How is folic acid deficiency treated?
  157. RDA recommendation for calcium in pregnancy?
    1000 mg/day
  158. Which foods are rich in calcium?
    Dairy, tofu, fish packed with bones, dark green leafy vegetables, fortified juice, TUMS
  159. RDA recommendation for fiber in pregnancy?
    28 g/day
  160. Which foods are rich in fiber?
    Fruits, vegetables, whole grains, beans, legumes
  161. RDA recommendation for Omega 3 fatty acids in pregnancy?
    300 mg/day
  162. Which foods contain omega 3 fatty acids?
    Oily fish, supplements, eggs, bread, juice, canola, sunflower and flaxseed oils, walnuts
  163. RDA recommendation for vitamin C in pregnancy?
    85 mg/day
  164. What is the most effective treatment for Pica?
    Buddy system
  165. How much caffeine can you have during pregnancy?
    No more than 200 mg/day
  166. How much fish can be consumed during pregnancy?
    Limit to 12 oz/wk
  167. Due to mercury levels, how much canned tuna can a pregnant woman have?
    4 oz or less/week
  168. What does puerperal mean?
  169. What is involution?
    Uterus returns to its normal position, shape and size
  170. What is the normal position, shape and size of the uterus?
    Pelvic organ, upside down pear, size of fruit basket pear (after pregnancy)
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Unit 3 and 4 OB
2013-02-02 22:54:35

Antepartal Period
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