Fetal Development and Lifespan

Fetal Lifespan

• DNA determines fetal sex.
• Umbilical vein carries oxygenated blood from placenta to fetus.
• Umbilical arteries carry deoxygenated blood and waste from fetus to placenta.
• Yolk sac provides nutrition and gas exchange for the embryo.
• Teratogens, medications, chemicals, radiation, cannabis, and alcohol/infections (like rubella) can cause birth defects.

Fetal Circulation

• Fetal circulation involves the umbilical cord.

Fetal Development

• Fetal respiratory system develops: breathing movements evident by weeks 11-14; surfactants produced by weeks 23-26; lungs fully developed by weeks 38-40.
• Fetal cardiovascular system develops, with the heart developed and pumping blood by week 6.
• Fetal genitourinary system develops with fully formed kidneys by weeks 31-34, and testes descending into the scrotum by week 6

Fetal Development(Cont.)

• Fetal musculoskeletal system development: muscles fully developed by weeks 35-37, and bones by week 37.

Contraindications for a Medication Abortion

• Contraindications include an intrauterine device (IUD) in place, ectopic pregnancy, anticoagulant therapy, and hemodynamic instability.

Potential Pregnancy Contraindications

• Severe kidney disease.
• Chronic kidney disease.
• Cardiovascular disease.
• Pulmonary arterial hypertension.
• Risk 40%-100% for maternal cardiac events during pregnancy.

Spontaneous Abortion Risk Factors

• Complete, incomplete, inevitable, threatened, and missed.
• Complete: all products of conception are expelled.
• Incomplete: some products are not expelled
• Inevitable: products cannot pass the cervix.
• Threatened: possible expulsion with bleeding and closed cervix
• Missed: embryo/fetus without sign of life.

Infant Born at 32 Weeks

• Review findings consistent with an infant born at 32 weeks.

Presumptive Signs of Pregnancy

• Client-reported symptoms suspected by the client.
• Amenorrhea (absence of menstruation).
• Breast tenderness.
• Fatigue.

Third Trimester Pregnancy Changes

• Hemorrhoids, swollen feet, insomnia, and tightness of the abdomen.

Fetal Anatomy Ultrasound

• Client education regarding fetal anatomy ultrasound should include instructions for a full bladder.

Leopold Maneuvers

• The Leopold maneuvers are used by providers to determine the fetus's position in the uterus.

Fetal Kick Counts

• Fetal kick counts need to be performed over 2-3 hours and over 10 movements per two hours are deemed normal.

Third Trimester Abnormal Findings

• Hemorrhoids, swollen feet, insomnia, abdomen tightness, bleeding, these are potential client manifestations of preterm labor.

Cardiovascular Changes During Pregnancy

• Maternal heart rate may be up to 20% above baseline.

Respiratory Changes During Pregnancy

• Maternal respiratory changes are also expected.

First Trimester Lab Tests

• Urinalysis may show minor traces of protein as normal.

True Labor Manifestations

• Increasing contractions, fluid leakage from the vagina, and blood-tinged vaginal mucus.

Glucose Challenge Screening

• NPO after ingesting glucose drink.
• One-hour check for blood glucose levels.
• Expected range less than 140.

High-Risk Pregnancy Review

• Pregnancy-related complications' risk evaluation.
• Nurse's role in high-risk pregnancies and communication between the nurse, provider, client, and support persons.
• Recommendations for alcohol use during pregnancy (none).

Prenatal Testing

• Client's ability to choose which tests are appropriate to performed is key.

GTPAL

• Assessment for Gravida, Term Births, Preterm Births, Abortions, and Living Children

High Blood Pressure Risk Factors During Pregnancy

• Maternal age over 35.

Nonstress Test (NST)

• Noninvasive method assessing fetal well-being externally.
• Expected outcome: fetal heart rate increases by at least 15 bpm for at least 15 seconds.

Alpha-Fetoprotein (AFP) Test

• Review for birth defects risk.

Preterm Premature Rupture of Membranes (PPROM)

• Review risk factors including amniotic fluid infection, polyhydramnios, and overdistended uterus (multiple pregnancies).

Nonmodifiable Risk Factors for Pregnancy Complications

• Age, genetics, race, and chronic illnesses.

Spontaneous Abortion Types

• Threatened, complete, incomplete, inevitable, and missed abortion.
• Septic abortion occurs when the products of conception become infected.

Ectopic Pregnancy Risk Factors

• Conditions affecting fallopian tubes.
• Age over 35.
• Endometriosis.
• Pelvic inflammatory disease.
• Smoking.

Marginal Placenta Previa

• During pregnancy, if the placenta doesn't migrate upwards sufficiently by the third trimester and stays near or over the cervix, this condition is known as marginal placenta previa.

Thrombophilia Risk Factors

• Inherited and acquired factors, first-degree relatives, and conditions like systemic lupus erythematosus (SLE) and other auto-immune conditions.

Molar Pregnancy Pathophysiology

• Review of risk factors for developing molar pregnancies.

Placental Abruption Risk Factors

• Polyhydramnios, smoking, cocaine use, age over 35, and high blood pressure.

Most Common Cause of Spontaneous Abortion

• Fetal chromosomal abnormalities.

Molar Pregnancy Findings

• Initial manifestations of viable pregnancy.

Spontaneous Abortion Diagnostics

• Ultrasound to assess gestational viability and fetal heart tones.
• High hCG levels.

Placenta Previa Manifestations

• Light, chronic, and intermittent bleeding.

Diagnosing Placenta Previa

• CBC, and coagulation studies.
• Ultrasound to rule out placenta previa, not a digital exam.

Acute Placental Abruption Management

• Start IV.
• Monitor vital signs.
• Monitor FHR.
• Turn client on their side.

Spontaneous Abortion Management

• Misoprostol for uterine evacuation of products of conception.

Molar Pregnancy Discharge Teaching

• Review of potential complications, contraception during treatment, and when to call the provider (heavy bleeding).

Cervical Insufficiency Management

• Progesterone to prevent premature delivery.

Thrombophilia Plan of Care

• Anticoagulation (low-molecular-weight heparin) and weekly nonstress tests (NSTs) at 36 weeks gestation.

Complete Molar Pregnancy Client Education

• Close monitoring of future pregnancies, risk for gestational trophoblastic neoplasia.

Cervical Insufficiency Priority Nursing Care

• Emotional support, preparation for cerclage placement.

Eclampsia Client Changes in Pregnancy

• Unexpected placental implantation, inadequate blood flow to the placenta, elevated blood pressure causing autoregulation dysfunction of the cerebral vasculature.

Preeclampsia with Severe Features Primary Cause

• Review of primary clinical manifestations of HELLP syndrome, and why magnesium sulfate is used for seizure prophylaxis in this context.

Gestational Hypertension Client Health Promotion

• Avoid smoking, alcohol, and high-sugar foods.
• Focus on good nutrition and exercise.
• Limit caffeine to 200 mg daily.
• Avoid supplements without checking with a provider.
• Attend all prenatal visits.

Oligohydramnios Primary Cause

• Chronic uteroplacental ischemia.

Hyperthyroidism Causes

• Autoimmune condition (Graves' disease), thyroiditis, and goiter.

Gestational Diabetes Mellitus vs. Pregestational Type 1 Diabetes

• Risk factors (genetic and familial history, BMI over 25), history of gestational and type 1 diabetes, and previous large-for-gestational-age infants are key differentiators.

Hyperemesis Gravidarum Causes

• Elevated hCG levels due to molar or multiple pregnancies, elevated estradiol levels, and related nausea.

Gestational Diabetes Testing

• Hemoglobin A1C monitored every two months during pregnancy and client education regarding this.

Hyperemesis Gravidarum Dehydration Symptoms

• Clinical manifestations of dehydration, such as a furrowed tongue, dry skin, dizziness, dark or strong-smelling urine, and headaches, rapid heart rate, and confusion.