OB test 1

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OB test 1
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2015-09-16 23:44:44
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  1. What is a big concern for teens who are pregnant?
    breach in confidentiality
  2. Before viability...
    mother's rights are paramount
  3. After viability...
    fetus's rights take precedence
  4. Infant mortality rate
    • # of infant deaths <1 yr/1000 live
    • births
  5. Neonatal mortality
    # of infant deaths < 28 days/1000 live births
  6. Fetal dealth
    death inutero @ more than 20 weeks gestation
  7. 5 leading causes of infant death in the U.S.
    • Congenital malformations
    • Short gestation/low birth weight
    • SIDS
    • Maternal complication
    • Unintentional injuries
  8. Maternal mortality rate
    # deaths during pregancy/ 100,000 live births

    *from conception-6 wks postpartum
  9. Maternal morality is 3x higher in
    black women
  10. Maternal-infant care is provided by
    • Drs
    • RNs
    • APNs
    • CNM
    • mid-wives
  11. Women who get divorced win custody ______% of the time and often do what?
    75

    accept lower child support for guaranteed custody
  12. What are the protective legislation for pregnant women?
    • They cant be denied a job if able to function in the role
    • Same rules apply to preg as disabled/sick leave
    • Medical coverage must include preg benefits
    • Mothers can use maternity benefits w/o penalty
  13. During oveulation, a sustained high level of _______ diminishes and _______ begins to elevate
    estrogen 

    progesterone
  14. When does ovulation typically occur?
    12-28 days into the cycle
  15. What is the true moment of conception?
    when nuclei of ovum and sperm swell and approach each other: membranes diappear and chromosomes pair up
  16. When is the egg usually fertilized?
    24 hrs after ovulation
  17. where does fertilization occur?
    in outer 1/3 of ampulla of the fallopian tube
  18. What causes the ovum to move?
    increased estrogen which causes peristalses in the fallopian tube
  19. what is the transit time of sperm?
    5-6 hrs
  20. What substance in the semen causes uterine smooth muscle to contract and increases the movement of sperm?
    prostaglandin
  21. What is cortical reaction?
    when the sperm penetrates the ovum and the inner layer of the ovum changes keeping out other sperm
  22. Risk for having fraternal twins
    • increased maternal age up to 35
    • increased parity
    • first 3 months of relationship
    • increased frequency of sex
    • family hx
  23. another word for faternal
    dizygotic
  24. parity
    the number of times you have been prengant and delivered a baby past 20 weeks.
  25. Phase 1 of development
    • All cells are the same
    • Rapid cell division
    • begins on 3rd day
  26. what is a blastocyst?
    inner solid mass of cells in phase 1
  27. what is a trophoblast
    outer layer of cells surrounding the cavity in phase 1
  28. Is the fetus exposed to what mom takes in during phase 1?
    no
  29. Phase 2
    • (implantation)
    • Blastocyst burrows in on day 7-9
    • Decidua over the blastocyst becomes the fetal part of the placenta
    • Decidua under the blastocyst becomes the mothers part of the placenta
  30. Phase 3
    • occurs 14 days after conception
    • blastocyst cells separate into 3 layers, each of which becomes a different part of the fetus
  31. Example of things that develop together?
    ears renal

    so if your baby is born deaf look at kidney function as well
  32. Chorion
    • First to form
    • holds amnion, embryo and yolk sac
    • develops from trophoblast
    • surface covered with villi
    • The disc where blood/gas exhange occurs
  33. Amnion
    • comes from exoderm
    • inside chorion
    • holds the amniotic fluid
    • it eventually expands to meet the chorion and form the amniotic sac
  34. Functions of amniotic fluid
    • cuchions fetus
    • helps control temperature
    • permits symmetric growth
    • prevents adherence tot he amnion
    • allows freedom of movement so aids in musculosketal development
  35. how mcuh amniotic fluid at 1 week
    30 ml
  36. how much amniotic fluid at 20 wks
    350 ml
  37. how much amniotic fluid at term
    about 1000 ml
  38. The fetus swallows about how much fetal urine per day?
    600ml
  39. <400 ml amniotic fluid
    olgohydraminos
  40. >2000 ml amniotic fluid
    hydraminos
  41. placenta should be placed where
    upper posterior
  42. placenta begins to develop at
    3rd week
  43. how much does placenta weigh?
    20 ounces
  44. Functions of placenta
    • fetal resp
    • fetal nutrition
    • fetal excretion
    • production of glycogen, cholesterol and fatty acids 
    • produces enzymes to increase fetoplacental transfer
    • breakes down epinepherine and histamine
    • stores glycogen and iron
  45. fetal glucose levels are _________ than moms
    30% lower
  46. what can cross the placenta through simple diffusion?
    • water
    • co2
    • chloride
    • anesthesia
    • gas
    • drugs
  47. What can cross the placenta through facilitated transport
    • glucose
    • galactose
    • some o2
  48. What crosses the placenta through active transport
    • amino acids
    • Ca
    • Fe
    • water soluble vitamins
    • glucose
  49. what crosses the placenta through pinocytosis
    • albumin
    • gamma glob
  50. fetal circulation begins
    4 weeks
  51. In the fetus ________ blood in vein, ________ blood in artery
    oxygenated

    deoxygenated
  52. what keeps the corpus leuteum functioning?
    HCG
  53. what causes corpus leuteum to secrete increased amounts of estrogen and proge?
    hCG
  54. what causes production of testosterone and causes male testes to grow?
    hCG
  55. what suppresses immunologic attack on the fetus by mom?
    hCG
  56. When is hCG present in maternal blood?
    8-10 weeks
  57. What decreases contraction of uterus to prevent abortion?
    progesterone
  58. progesterone is produced by placenta after
    10 weeks
  59. after 7 weeks, placenta produces
    50% of maternal estrogen
  60. estrogen causes...
    • enlargement of uterus, breast and breast glandular tissue
    • increases vascularity and vasodilation in villi
  61. What is the connective tissue of the umblicial cord called and what does it hold?
    Wharton's jelly

    2 umbilical arteries and 1 umbilical vein
  62. how long is cord?
    22 inch and 0.8 cm across
  63. Nuchal cord
    cord born around neck
  64. Ductus venosis
    shunts blood away from fetal liver into right side of fetal heart
  65. Foramen ovale
    shunts blood away from right side of heart into left side if there is more pressure on the right side.
  66. the right side of the heart has more pressure because
    of resistance to blood flow into the lungs
  67. ductus arteriosus
    shunts blood away from the fetal lungs into the fetal aorta
  68. Fetal hgb carries __________ more o2 than adult hgb
    20-30%
  69. uterus size increases how much
    10 ml to 5.1 L due to hypertrophy in response to estrogen
  70. Chadwicks sign
    bluish purple discoloration of cervix due to increased blood flow
  71. goodell sign
    softening of cervix due to vascularization
  72. urinary frequency occurs in
    1st and 3rd
  73. linea nigra
    dark line from umbilicus to pubis
  74. recommended weight gain
    25-35 lbs
  75. Hegar sign
    softening of isthmus of uterus (area cervix and body of uterus)
  76. McDonald sign
    ease in flexing the body of the uterus against the cervix
  77. Fetal heart rate can be detected when
    10-12 wks
  78. fetal movement detected
    • 20 weeks for first time
    • 16 weeks for 2+
  79. Nagels rule of EDD
    date of LMP minus 3 months, add 7 days
  80. McDonalds method of EDD
    measure distance from top of symphasis pubis over abdomin to top of fundus

    fundal height correlates with weeks of gestation between 22-34 weeks
  81. Most reliable way to determine EDD
    ultrasound in the 1st trimester
  82. TPAL
    • T # of term births
    • P # of preterm births
    • A # abortion
    • L # currently living children that they gave birth to
  83. prenatal schedule
    • 1x/month for 28 weeks
    • 2x/month for 28-36 weeks
    • 1x/week for 36 weeks
  84. temp is concerning in mother if above
    101
  85. hyperemesis gravidarum
    persistent vomiting
  86. management for N/V
    • avoid strong odors
    • drink carbonated beverages
    • eat crackers/toast before getting out of bead
    • avoid spicy/greasy foods
  87. management for ptyalism
    gum, mints, hard candy, mouth wash

    gone by 1st
  88. nasal stuffiness/bleeding management
    COOL mist vaporizer
  89. mom cant have afrin unless
    going on plane
  90. alpha feto protien level to screen for neural tube when?
    16-18 weeks
  91. maternal blood glucose challenge test
    24-28 weeks
  92. fetal hr
    120-160
  93. pregnant women need extra _______ calories in 2nd and 3rd trimesters
    350-450
  94. No aspertame for
    mom who has PKU
  95. protien requirements
    71 g/day

    • Milk, cheese
    • Meat, fish, poultry
    • egg
    • cook dried beans and peas
    • peanut butter
    • soy milk
  96. sources of folic acid
    • black beens
    • kidney beans
    • pinto beans
    • OJ
    • green peas
    • broccoli
    • cooked spinach
  97. iron requirements
    27 mg/day

    • cook in cast iron pots
    • consume ascorbic acid, meat fish and poultry
    • lentils
    • lima beans
    • penuts and sunflower seeds
    • egg
    • raisin bran 
    • broccoli
    • cooked spinach
  98. calicum requirements
    no change

    • transfers to baby at expense of mother
    • preterm miss out on the calcium
  99. Meal planning
    • Diary= 3/day
    • Protein= 7 oz/day
    • Veg= 2.5
    • Fruit= 2
    • Grains= 7
    • Oils= eat sparingly
  100. Safe to eat up to 12 oz/ wk of lower mercury fish such as
    • shellfish
    • canned light tuna
    • shrimp
    • salmon
    • catfish
    • pollack
  101. Do not eat these type of fish
    • swordfish 
    • shark
    • tilefish
    • king mackkerel
    • albacore tuna
  102. GDM screening
    24 wks-28

    >130-140
  103. GDM goes away when
    1-2 postpartum
  104. insulin requirements may _______ @ end of pregnancy
    triple
  105. Maternal risks for GDM
    • increased amniotic fluid
    • pre E, E
    • retinopathy
    • vaginitis
    • UTI
  106. 3hr GTT
    eat high carb diet x 3 days. Fast night before. Injest 100g glucose. BG assessed for 3 hrs

    • Fasting=>95
    • 1 hour= >180
    • 2 hr= >155
    • 3 hr=> 140
  107. GDM pts need _______ extra calories/day with 3 meals and 3 snacks
    300
  108. GDM checks
    • 18 weeks- ultra sound
    • 16-20 weeks- alpha feto protein
    • 28 weeks= ultra sound for fetal growth, started weekly
  109. Preeclampsia
    • BP > 140/90 
    • 2x, 6 hr apart
    • Proteinuria +2
    • Edema
    • wt gain >2 lb/wk
    • hyper reflexia +3
  110. Severe Eclampsia
    • BP >160/120
    • proteinuria +3
    • visual disturbances
    • severe edema
    • pulmonary edema
    • epigastric pain
    • HELLPS syndrome
    • H-hemolysis
    • EL- elevated liver enzymes
    • LPS- low platelets
    • elevated hct
    • DIC
  111. Eclampsia
    all s/s for pre/severe exlamsia +

    • Grand mal seizures
    • Coma
    • Hyperthermia
  112. s/s for developing eclampsia
    • elevated DTR
    • blurred vision
    • dark spots, flashing lights
    • severe HA
    • pulmonary edema
    • epigastric pain
  113. Risk factors for E
    • never pregnant
    • poor nutrition
    • family hx PIH
    • multipara by new partner
    • multiple gestation
    • pre-existing vasc/renal disease
    • molar pregnancy
    • large placenta
    • RH diabetes
  114. Labs for E
    • hct elevated
    • liver enzymes elevated
    • low platelets
    • DIC profile
    • elevated uric acid above 3.7
    • proteinuria
    • magnesium
  115. if liver capsule ruptures due to E
    • right shoulder pain
    • epigastric pain
    • hematoma
    • death 50%
  116. mg dosage for E
    4-6 mg over 15 min then 1-2 g/hr
  117. antidote for mag
    calcium gluconate 1 g IV/3 min
  118. for pre E, restrict sodium less than
    6 g/day
  119. most common cause of bleeding in 1st and 2nd tri
    abortion
  120. Threatened abortion
    • Bleeding, cramping, back ache
    • duration hours-several days
    • cervix remains closed
    • outcome: may or may not lose it
  121. Imminent abortion
    bleeding, cramping

    • cercix dilates
    • outcome= loss
  122. Complete abortion
    • All products of conception expelled
    • uterus contracts
    • cervix can still dilate or appear closed
  123. Incomplete abortion
    • part of products remain
    • cervix dilated
    • requires D&C
  124. Missed aboriton
    • fetus dead but not expelled
    • no increase in fetal size
    • may have brown spotting
    • cervix closed
    • danger of D&C, especially if retained >4 wks
  125. Habitual aborter
    >3 consecutive miscarriages
  126. Septic abortion
    infection, premature rupture of membranes or result of criminal attempt to abort
  127. Risks for abortion in 1st tri
    • fetal problems:
    • congenital anomolies from teratogens
    • faulty implantation
    • weak cervix
    • endocrine imbalance
    • infection (toxoplasmosis, CMV, rubella)
  128. risks for abortion in 2nd and 3rd tri
    • maternal problems:
    • PIH 
    • DM
    • Maternal illness
  129. risks for eptopic
    • tubal damage (PID)
    • pelvic surgery
    • endometriosis
    • previous eptopic
    • IUD
    • decreased progesterone
    • congenital anomaly
    • IVG
    • age
    • douching
  130. leading cause of maternal death in 1st trimester
    eptopic pregnancy
  131. risk for placenta previa
    • multiparity
    • increased age
  132. risk for abruption
    • cocain
    • hx of abruption
    • increased IUP
    • increased BP
    • smoking
    • alcohol
    • increaed age
    • increased parity
    • trauma
  133. Marginal abruption
    • separation at edges
    • vag bleeding
  134. central abruption
    • center
    • traps blood so no bleeding
  135. Complete abruption
    • massive bleeding
    • DIC 
    • hysterectomy
  136. babies die from abruption how often
    30-50% of the time
  137. alcohol affects as early as
    3-8 weeks
  138. methadone does or does not cross placenta
    does
  139. Class 1 heart disease
    • asymptomatic
    • no activity limit 
    • do fine during preg
  140. Class 2 heart disease
    • slight limitation
    • ok @ rest, but occur with normal activity: SOB, fatigue, angina
  141. Class 3 heart failure
    • Marked activity limitation
    • but less than ordinary phsycial activity
  142. Class 4 hear disease
    • cant carry on activity 
    • s/s at rest
  143. For heart disease patients, how should you deliver?
    vacuum or forcept assisted
  144. ultra sound 1st tri
    for dx of pregnancy and assessment of gestational age

    accurate up to 12 wks
  145. CVS in 1st tri
    done @ 8-12 wks
  146. Fetoscopy
    11-36 wks

    blood/skin sample from fetus
  147. Percutaneous umbilical blood sampling in 1st tri
    genetic disorders
  148. Alpha fetoprotien test
    • neural tube
    • 16-18 wk
  149. ultrasound in 2nd tri
    • physical characteristics
    • fetal structures
    • gestational age
    • fetal measurements
  150. Amniocentesis
    • chromosomal assessment
    • 16-18 wks
  151. 3rd tri ultrasound
    fetal well being
  152. biphysical profile
    3rd tri

    • amount of amniotic
    • fetal breathing
    • body tone
    • body movement
    • FHR accel
  153. Non-stress test
    • 3rd tri
    • after 30 wks
    • Reactive good= 2+
    • accelerations of 15+ beats in 20 min
  154. Contraction stress test
    3rd tri

    • nont done till after 24 wks
    • IV oxytocin elicits contractions til you have 3 in 10 min
    • negative is good= no late decels
    • positive bad= late decels w at least 2 contractions
    • Equivocal (suspicious)= 1 late decel (repeat in 24 hr)

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