maternity ch. 4

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maternity ch. 4
2013-02-08 16:08:03

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  1. antepartum (antepartal) period
    begins with conception and ends with onset of labor
  2. preconception care
    • set of interventions that aim to identify medical, behavioral, and social risks to a womans health or pregnancy outcome through prevention and management.
    • -health promotion and risk screening
  3. 2 components of preconception health care visits
    physical examination and laboratory diagnostic tests
  4. anticipatory guidance
    provision of info and guidance to women and their families that enables them to be knowledgeable and prepared as the process of pregnancy and childbirth unfold.

    includes: nutrition, prenatal vitamins, exercise, self care, contraception cessation, timing of conception, modifying behaviors to reduce risks
  5. maternal obesity can cause:
    macrosomia, complications during child birth, prolonged labow, postpartum hemorrhage, poor wound healing, increased risk for antepartum complications, clots, uti, small gestational age and preterm birth.
  6. prenatal vitamins
    • folic acid-decreases neural tube defects
    • calcium, magnesium, vit. D-contributes to bone health
    • iron supplements-prevent anemia
  7. presumptive signs of preganancy
    physiological changes perceived by the woman herself

    • -ammenorrhea:absence of period
    • -nausea and vomitting
    • -breast changes
    • -fatigue
    • -urination frequency
    • -quickening:womans first awareness of fetal movement (around 18 weeks)
  8. probable signs of pregnancy
    objective signs-all physiological and anatomical changes that are perceived by the health care provider

    • -chadwicks sign: bluish-purple coloration of the vaginal mucosa, cervix, and vulva at 6-8 weeks
    • -goodells sign: softening of the cervix and vagina with increased leukorrheal discharge (palpated at 8 weeks)
    • -hegars sign: softening of the lower uterine segment (palpated at 6 weeks)

    -uterine growth and abdominal growth

    • -skin hyperpigmentation:
    • -melasma (choasma) mask of pregnancy
    • -linea nigra: dark line that runs from the belly button to the pubes
    • -nipples and areola become darker

    -ballottement: light tap of the examining finger to rise the amniotic fluid and then rebound to its original position (16-18 weeks)
  9. positive sings of pregnancy
    objective signs of pregnancy attributed by the fetus

    • -fetal heart (10-12 weeks)
    • -palpation of fetal movement
    • -sonogram of the fetus (cardiac movement (4-8 weeks)
  10. sonograms
    • -can see gestational sac at 5 weeks
    • -can see fetal cardiac activity from 6-7 weeks
  11. calculation of due date (EDB EDD)
    Naegele's Rule: first day of LMP-3 months+7 days

    Gestational Wheel: less reliable then the Naegele's Rule
  12. regular length of pregnancy
    37-42 weeks
  13. Trimesters
    • First Trimester: 1st day of LMP-12 completed weeks
    • Second Trimester: 13-27 weeks
    • Third Trimester: 28-40 weeks
  14. 3 parts of the uterus
    • -fundus: upper portion
    • -isthmus: lower segment
    • -cervix: lower part or neck, the external part of he cervix interfaces with the vagina
  15. leukorrhea
    vaginal discharge
  16. what places pregnant women at risk for yeast infections?
    candida albicans
  17. endometrium
    uterus lining
  18. hemodynamic changes during pregnancy
    • -blood volume increases by 1,500 ml or by 40-50% (hypervolemia of pregnancy)
    • -blood vol. increases to support uteroplacental demands and maintenance of pregnancy
    • -plasma and RBC vol. increases in response to increased uteroplacental and renal perfusion needs
    • -cardiac output increases 30-50% with an increase of 15-20 beats per min.
    • -enlarging uterus can compress the inferior vena cava
    • -this is a protective mechanism for the inevitable intrapartum blood loss
  19. cardiovascular anatomical changes
    • -heart enlarges slightly as a result of hypervolemia and increased cardiac output
    • -the heart shifts upward and laterally as the growing uterus displaces the diaphragm
  20. cardiovascular hematological changes
    • -RBC count increases 30% and RBC vol. increases 17-33% in response to increased oxygen requirements
    • -blood vol. expansion leads to physiological  anemia (psuedoanemia of pregnancy due to hemodilution)
    • -iron deficiency anemia, hemoglobin less than 11 g/dl and hematocrit less than 33%
    • -wbc count increases with values up to 15,000 in absence of infection
    • -hypercoagulation occurs to decrease risk of postpartum hemorrhage (puts mom at risk for clots)
  21. resp. system
    • -tidal vol. increases
    • -slight resp. alkalosis (promotes transport of co2 away from fetus)
  22. anatomical changes
    • -diaphragm is displaced upward
    • -shift from abdominal thoracic breathing
    • -increase in chest circumfrance
    • -can contribute to physiological dyspnea
  23. renal system
    physiological changes: renal plasma flow increases, GFR increases, renal tubular reabsorption increases, proteinuria and glucosuria can occur in small amounts, shift in fluid and electrolyte balance, positional variation (left lateral recumbant position)

    anatomical changes: renal pelvis dilation with increased renal plasma flow, ureter alterations, urinary stasis, hyperemia of bladder and urethra, frequency, urgency, and nocturia
  24. gastrointestinal system
    • -nausea and vomiting, increase in appetite
    • -anatomical changes: uterine enlargement displaces stomach, liver, and intestines, appendix is situated high and to the right, slowing of digestive processes, gallstones (due to progesterones smooth muscle relaxation), pruritus, ptyalism (increase in saliva), bleeding from gums
  25. musculoskeletal system
    -hyperpigmentation, stretch marks (striae), varicosities, spider nevi, palmer erythema, oily skin and acne, sweating
  26. endocrine system
    hormonal production and size of thyroid gland increases
  27. prenatal period
    pregnant to birth
  28. G/P
    two digit system to denote pregnancy and birth
  29. gravida
    number of times a woman has been pregnant
  30. para
    any birth within 20 weeks of gestation, regardless of whether the baby was alive or not
  31. gtpal
    • obstetrical history, number of term infants, preterm infants, abortions and living children.
    • -t=number of term infants
    • p=number of preterm
    • a= abortion
    • l=living children
  32. nulligravida
    never been pregnant or given birth
  33. primigravida
    pregnant for first time
  34. multigravida
    pregnant for at least the 2nd time
  35. primipara
    pregnant with first baby but has not given birth yet
  36. quickening
    when you feel the baby move for the first time
  37. rhogam
    • administered to mothers with rh negative antibody scree results
    • -administered at 28 weeks to prevent isoimmunization and the risk of hemolytic disease in fetus
  38. normal weight gain for mothers
    • underweight 28-40
    • average weight 25-35
    • overweight 15-25
    • obese 15
  39. signs and symptoms of preterm labor
    lower abdominal cramping, lower backache, pelvic pressure, lack of amniotic fluid, increased vag. discharge, vag. spotting or bleeding
  40. signs and symptoms of hypertensive disorders
    severe backache, visual changes, facial or generalized edema
  41. fetal movement count
    • kick counts
    • 10 distinct movements within 2 hrs or 4 within 1 hr
  42. leopolds maneuvers
    palpation of the abdomen to identify the position of the abdomen