ch. 4 from notes

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silvisaj44
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200131
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ch. 4 from notes
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2013-02-12 19:57:54
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maternity
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  1. antepartum
    • -through pregnancy
    • -prenatal period
    • -begins with conception
    • -ends with onset of labor
  2. two components of preconception
    routine physical exam and health screening
  3. pre-pregnancy weight
    • underweight-bmi less than 19.8 gain 28-40 lbs
    • average-bmi 19.8-26.0 gain 25-35
    • overweight-bmi 26.1-29 gain 15-25
    • obese-bmi greater than 29 gain 15
  4. maternal obesity
    • increased risk for:
    • -spontaneous abortion (miscarriage)
    • -gestational diabetes
    • -preeclampsia (rise in maternal bp)
    • -labor induction
    • -cesarean birth
    • -poor wound healing
    • -high risk of fetal anoloties
  5. prenatal vitamins
    • folic acid
    • calcium and vit. d
    • magnesium
    • iroin
  6. tobacco and pregnancy
    • -linked to low birth weights, prematurity
    • higher rates of neonatal mortality, spontaneous abortions, stillborn, etc
  7. alcohol and pregnancy
    linked to fetal alcohol syndrome with resultant mental retardation and growth deficiencies, no minimum safe levels!
  8. pelvic tilts
    prevents back strain and increases abdominal muscles.
  9. contraception
    • -hormonal contraception: need 2-3 menstrual cycles before attempting to conceive
    • -depo-provera: takes several months or more to conceive, possibly up to a year
    • -iud: wait 1 month before attempting to conceive
  10. diagnosis of pregnancy
    • 1) presumptive signs
    • 2) probable signs
    • 3) positive signs
  11. presumptive signs
    • -subjective
    • -amenorrhea
    • -nausea and vomiting
    • -excessive fatigue
    • -urinary frequency
    • -breast changes
    • -quickening
  12. probable signs
    • -objective
    • -changes in pelvic organs
    • -Goodells sign
    • -Chadwicks sign
    • -Hegars sign
    • -enlargement of abdomen
    • -hyper pigmentation of the skin
    • -ballottement
    • -positive preg. tests
    • -clinical preg. tests
    • -OTC preg. tests
  13. Chadwicks sign
    bluish purple coloration of the vaginal mucosa, cervix, and vulva seen at 6-8 weeks
  14. Goodells sign
    softening of the cervix and vagina with increased leukorrheal discharge; palpated at 8 weeks
  15. Hegars sign
    softening of the lower uterine segment; palpated at 6 weeks
  16. hyperpigmentation
    • -Melasma (chloasma): mask of pregnancy, brownish pigmentation over the forehead, temples, cheek and upper lip
    • -Linea Nigra: dark line that runs from the umbilicus to the pubes
    • -darkening of the nipples and areola
  17. ballottement
    light tap of the examining finger on the cervix that causes the fetus to rise to rise in the amniotic fluid and then rebound to its original position- occurs at 16-18 weeks
  18. positive signs
    • objective signs that can be attributed by the fetus
    • -FHR 10-12 weeks
    • -palpation of the fetus
    • -sonographic visualization
  19. Nageles Rule
    LMP-3 months+7 days=EDB
  20. EDB
    • Nageles rule
    • quickening
    • fetal heart beat(8-12 weeks)
    • ultrasound
    • -fetal sac (5-6 weeks)
    • -fetal heart activity (6-7 weeks)
    • -BPD measurements (12-13 weeks)
  21. Trimesters
    • 1: LMP-12 weeks
    • 2: 13-27 weeks
    • 3: 28-40 weeks
  22. parts of the uterus
    • fundus (top)
    • isthmus (body)
    • cervix (opening)
    • endometrium (inside)
  23. cardiovascular and circulatory system
    • -increase blood flow to uterus, placenta and breasts
    • -increase blood volume (rbc's and plasma)
    • -cardiac output increases
    • -increase pressure on blood vessels
    • -heart enlarges because of hypervalemia, shifts up and to the left

    • resulting symptoms
    • -increase HR
    • -decrease BP
    • -physiologic anemia of pregnancy
    • -dependent edema
    • -hemorrhoids
    • -postural hypotension
    • -supine hypotensive sundrome
  24. respiratory system
    • -o2 needs increase
    • -need to oxygenate fetal and maternal blood
    • -growing uterus presses on diaphragm
    • -increase in tidal volume, slight hyperventilation

    • resulting symptoms
    • -mild SOB
  25. Increases in what hormones?
    • -estrogen
    • -progesterone
    • -prostaglandins (causes vascular engorgement and smooth muscle relaxation)

    • resulting symptoms:
    • -nasal stuffiness
    • -epistaxis-nose bleeds
  26. renal system
    • urinary tract/ kidney changes
    • -increase pressure on bladder (1 and 3 trimesters)
    • -decrease bladder capacity-bladder flattens out
    • -renal plasma flow increases
    • -ureters elongate and dilate
    • -GFR increases

    • resulting symptoms:
    • -urinary frequency
    • -hyperemia
    • -glycosuria-excrete glucose in urine
    • -urinary stasis
  27. GI System
    • metabolism changes
    • -smooth muscles relax (progesterone)
    • -delayed gastric emptying
    • -decrease peristalsis
    • -cardiac sphincter relaxes
    • -gallbladder empties slower
    • displacement of stomach, intestines, and liver

    • resulting symptoms:
    • -nausea and vomiting
    • -bloating and constipation
    • -heartburn due to reflux
    • -prone to gallstones
    • -weight gain
  28. musculoskeletal
    • -pelvic joints relax (progesterone and relaxine)
    • -lumbar curve accentuates
    • -rectus abdominus muscle may seperate
    •  
    • resulting symptoms:
    • -waddling gait
    • -posture changes
    • -lordosis
    • -diastasis recti
  29. integument system
    • skin and hair changes
    • -increase pigmentation
    • -decrease connective tissue strength
    • -increase subcutaneous blood flow
    • -decrease rate of hair growth

    • resulting symptoms
    • -linea nigra
    • -melasma (mask)
    • -striae (stretch marks)
    • -varicosities
    • -spider nevi
  30. endocrine system
    • -increase need for insulin
    • -pancreatic islets of Langerhans respond and increase insulin secretion. Gestational diabetes may occur if pancreas unable to function.
    • -pregnancy specific hormones: increase hCG level in early pregnancy
    • -after the development of the placenta, it produces most of the common pregnancy hormones
    • -estrogen
    • -progesterone
    • -human placental lactogen (hPL)
    • -relaxin
  31. Immune System
    -process of the maternal immune system becoming tolerant of the foreign body
  32. 3 questions for intimate partner violence
    1) within the past year have you been hit, slapped, kicked, or otherwise physically hurt by anyone?

    2) since you have been pregnant have you been hit, slapped, kicked or otherwise physically hurt by anyone?

    3) within the last year has anyone forced you to have sexual activities?
  33. gravida
    # of times pregnant-doesnt matter with twins or triplets
  34. parity (para)
    any birth after 20 weeks
  35. abortion
    loss of fetus before 20 weeks
  36. GTPAL
    gravida, term, preterm, abortion, living
  37. nulligravida
    never been pregnant
  38. primigravida
    1st time pregnant
  39. multigravida
    pregnant more than once
  40. gestation
    length of pregnancy
  41. intrapartum
    while in labor
  42. postpartum
    after labor
  43. Leopolds Maneuver
    palpation of the abdomen to identify the position of the fetus

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