Exam 1- OB.docx

**Physiologic adaptations to pregnancy:** 1. **What changes does the uterus undergo?** a. Hypertrophy of uterine wall b. Softening of vaginal muscle and connective tissue in preparation for birth c. Uterus contractibility increases leading to Braxton-Hick's contra...

**Physiologic adaptations to pregnancy:** 1. **What changes does the uterus undergo?** a. Hypertrophy of uterine wall b. Softening of vaginal muscle and connective tissue in preparation for birth c. Uterus contractibility increases leading to Braxton-Hick's contractions. d. Hypertrophy of cervical glands formation of mucus plug i. Protective barrier between uterus/fetus and vagina e. Enlargement and stretching of uterus f. Expanded circulatory volume increase vascular congestion g. Abdominal muscle stretch diastasis recti h. Increased vascularity and hypertrophy of vaginal and cervical glands increase leukorrhea i. Amenorrhea 2. **What is the impact of hormones on smooth muscle?** j. Muscle relaxation ii. Respiratory Estrogen, Progesterone and Prostaglandins 1. Dyspnea 2. Nasal and sinus congestion 3. Epistaxis iii. Renal Progesterone 4. Increase in UO 5. Incontinence 6. Increased risk for UTI iv. GI Progesterone 7. Bloating 8. Flatulence 9. Constipation v. Relax SM in Cervix and pelvic floor ligaments Estrogen, Progesterone 3. **What causes edema in the lower extremities? How can this be relieved?** k. **Causes**: vi. Increased venous pressure vii. Decreased blood flow due to compression of iliac veins and inferior vena cava viii. Decreased renal flow in 3^rd^ trimester l. **Relief** ix. Not laying on back to prevent compression of inferior vena cava Sleep on left side x. Elevation xi. Hydration xii. Exercise xiii. Compression Socks xiv. Prolong sitting or standing 4. **What causes nasal and sinus congestion?** m. Increased estrogen, progesterone and prostaglandins 5. **What changes in lab values might occur as a result of adaptations of the cardiovascular system?** n. ↑RBC count and volume o. ↑ plasma volume p. ↓Hgb \ j. **Daily fetal movement counts (FMC)** x. Maternal surveillance (maternal perceptions of fetal movement) after \~28 weeks xi. Two approaches: 5. 2 hour- perception of 10 distinct fetal movements 6. 1 hour- 4 movements xii. If fetal movement not detected after eating or drinking instruct to lie on side k. **Vibroacoustic stimulation (VAS)** xiii. Used when NST is non-reactive xiv. Done by activating an artificial larynx on maternal abdomen near the fetal head in conjunction with NST 7. Can be repeated at 1min intervals for up to 3 times xv. **Reactive=** FHR increase by 15bpm above baseline for 15 second at least 2 times in 20min l. **Contraction Stress Test** xvi. Used for terms patients (\37 weeks) with a non-reactive NST to assess fetus ability to maintain a normal FHR in response to uterine contractions xvii. Results 8. **Negative (Normal)=** no deceleration in FHR on a 10min strip with 3 contractions. With the contractions lasting no more than 40 seconds 9. **Positive (Abnormal)=** late decelerations in FHR with 50% of contraction b. Late deceleration begins after the onset of contraction and FHR reaches lowest point (nadir) after peak of the contraction i. This shows that baby doesn't have enough oxygen reserve when supply id cut off during contraction xviii. Risk: 10. High false positive rate due to short monitoring periods m. **Amniotic Fluid Index (AFI)** xix. Measures pockets of amniotic fluid w/in 4 quadrants of the uterine cavity via U/S to assess fetal well-being and placental function xx. Results 11. **Normal-** \~AFI= 8cm to 24cm 12. **Abnormal-** c. Oligohydramnios= AFI \< 5cm d. Polyhydramnios= AFI \>24cm n. **Biophysical profile** xxi. 30 min U/S with NST xxii. Modified 13. NST w/ AFI e. **Normal-** Reactive NST and AFI \>5cm 14. Why? f. Less time g. Considered most predictive of perinatal outcomes 4. **What is the difference between a diagnostic test and a screening test?** - **Designed to identify individuals who are not affected by a disease or abnormality.** - Non-diagnostic. If a screening test indicates an abnormality, further testing is indicated. - Amniotic fluid index (AFI) - Biophysical profile - Contraction stress test - Daily fetal movement count - Multiple marker screening - Nonstress test (NST) - Ultrasonography - Nuchal translucency - Umbilical artery doppler flow - Vibroacoustic stimulation - - - - - - - 5. **What is included in a biophysical profile?** o. NST w/ 30min U/S p. Indicators xxiii. FHR activity xxiv. Fetal breathing movement xxv. Fetal movement xxvi. Fetal tone xxvii. AFI q. Scoring xxviii. 8/10- reassuring xxix. 6/10- equivocal repeat testing xxx. 4/10- non reassuring further evaluation need xxxi. 2/10- indication for immediate delivery **Diagnosing pregnancy:** 1. **Presumptive signs** a. Amenorrhea: Absence of menstruation b. Nausea and vomiting: Common from week 2 through 12 c. Breast changes: Changes begin to appear at 2 to 3 weeks i. Enlargement, tenderness, and tingling ii. Increased vascularity d. Fatigue: Common during the first trimester e. Urination frequency: Related to pressure of enlarging uterus on bladder; decreases as uterus moves upward and out of pelvis f. Quickening: A woman's first awareness of fetal movement; occurs around 18 to 20 weeks' gestation in primigravida (between 14 and 16 weeks in multigravidas) 2. **Probable signs** - Uterine growth and abdominal growth - Skin hyperpigmentation - Melasma (chloasma), also referred to as the mask of pregnancy: brownish pigmentation over the forehead, temples, cheek, and/or upper lip - Linea nigra: Dark line that runs from the umbilicus to the pubis - Nipples and areola: Become darker - Ballottement: A light tap of the examining finger on the cervix causes fetus to rise in the amniotic fluid and then rebound to its original position; occurs at 16 to 18 weeks 3. **Positive signs** g. Auscultation of the fetal heart, by 10 to 12 weeks' gestation with a Doppler h. Observation and palpation of fetal movement by the examiner after about 20 weeks' gestation i. Sonographic visualization of the fetus: Cardiac movement noted at 4 to 8 weeks 4. **Hormone(s) detected in a urine pregnancy test** j. Laboratory tests are based on detection of the **presence of hCG (human chorionic gonadotropin)** in maternal urine or blood. k. A maternal blood pregnancy test can detect hCG levels before a missed period. l. A urine pregnancy test is best performed using a first morning urine specimen, which has the highest concentration of hCG and becomes positive about 4 weeks after conception. m. **Home pregnancy test** iii. Urine test that uses enzymes and relies on color change when agglutination occurs, indicating a pregnancy. **Preconception and prenatal care** **What are components of an initial prenatal visit?** a. **Initial prenatal visit:** i. Comprehensive and risk health assessment ii. Pregnancy hx iii. Physical and pelvic exam iv. EDD v. Nutrition assessment 24hr recall vi. Psychosocial assessment vii. Assessment of intimate partner violence b. **Blood type and Rh factor** c. **Antibody screen** d. **CBC,** including: viii. Hemoglobin/ Hematocrit ix. RBC count x. WBC count xi. Platelet count e. **RPR, VDRL (syphilis serology)** f. **HIV screen** g. **Hepatitis B screen (surface antigen)** h. **Rubella titer** i. **PPD (tuberculosis screen)** j. **Urinalysis** k. **Urine culture and sensitivity** l. **Pap smear (if indicated)** m. **Gonorrhea and chlamydia cultures** n. **Chorionic villus sampling** 10-12 weeks 1. **What does teratogenesis mean?** o. Production of congenital malformations in developing fetus due to exposure to teratogens (harmful agents) 2. **Which topics in terms of prenatal education should be addressed depending on the trimester? (Examples)** p. Pain relief in labor 3^rd^ trimester q. Postpartum care 3^rd^ trimester r. Early discomforts of pregnancy 1^st^ trimester s. Breastfeeding 3^rd^ trimester t. Signs of labor 2^nd^ trimester u. Parenting and infant care3^rd^ trimester 3. **How is an obstetric history documented according to GTPAL?** v. G = Number of times pregnant w. T = Number of term infants born (37+ weeks) x. P = Number of preterm infants born (twin births count as 1 birth) y. A = Number of abortions (spontaneous or induced) z. L = Number of children currently living 4. **When should an individual anticipate screening for gestational diabetes?** a. 24-28 weeks 5. **When is GBS screened for in pregnancy?** b. 35-37weeks 6. **How is infertility defined?** c. \35 6 months of inability to conceive and maintain a pregnancy **Pregnancy and fetal development:** 1. **Where does fertilization occur in the reproductive tract?** a. **Outer third of the fallopian tube** i. Sperm nucleus enters the nucleus of the oocyte zygote formed w/ 46 chromosomes (pair from each parent) ii. Then cell division occurs creating a **blastocyst** 1. Has two parts: a. **embryoblast** develops into the embryo b. **trophoblast** part of the placenta iii. The blastocyte embeds into the endometrium in the uterine wall 2. **What structures are specific to the fetal circulatory system?** b. **Ductus Venosus** iv. Connects umbilical vein to inferior vena cava through the placenta 2. Highly oxygenated blood enters RA of fetus c. **Foramen Ovale** v. Opening between RA and LA 3. Oxy bloods shunted to LA via foramen ovale 4. After birth (up to 3 months) closes in response to increased blood retuning to LA d. **Ductus arteriosus** vi. Connect pulmonary artery to descending aorta 5. Majority of oxy blood shunted to aorta via ductus arteriosus with small amount to lungs 6. After birth (once umbilical cord is cut) ductus arteriosus constrict in response to higher O2 levels and prostaglandins 3. **What is the function of the placenta and how is it formed?** e. Formed from both fetal and maternal tissue vii. Two sides: 7. **Fetal side-** c. Chorionic membrane d. Developed from trophoblast e. Chorionic villi projections from chorion to be embedded into the decidua basalis (layer of endometrium) i. Forms placenta fetal blood vessels 8. **Maternal side-** f. Decidua basalis g. Cotyledons formed from divided decidua basalis into lopes h. Prevention of maternal fetal blood mixing i. Allows gas exchange of gases, nutrient and electrolytes f. Function viii. **Metabolic and gas exchange** 9. via diffusion and active transporttake nutrients and remove fetal waste products and CO~2~ ix. **Hormone production** 10. Estrogen stimulates growth of breast and uterus 11. Progesterone promotes implantation and decrease uterine contractility x. **hCG** 12. stimulates corpus luteum to produce estrogen and progesterone until placenta takes over xi. **hPL** (human placental lactogen) 13. promotes fetal growth by regulating glucose 14. Stimulate breast development for lactation 4. **What is the function and anatomy of the umbilical cord?** g. Function xii. Connects fetus to placenta surround by Wharton jelly to protect from vessel compression h. Structure xiii. Should have 2 arteries (carries deoxy blood) and one vein (carries oxygenated blood) 5. **What is the function of amniotic fluid?** i. Cushion fetus j. Prevent adhesion to amniotic membrane k. Allow baby to move freely l. Provide consistent thermal environment 6. **At what gestational ages is a pregnancy considered in the embryonic phase?** m. Implementation to 8 weeks 7. **When can fetal heart tones be auscultated?** n. 6-7 weeks via U/S 8. **How is fundal height measured in pregnancy and what anatomical marker on the body usually corresponds to 20 weeks gestation?** o. Pt supine locate the fundus start at the umbilicusmeasure from the pubic symphysis to top of fundus record measurement p. Fundus at umbilicus at 20 weeks xiv. Usually increase 1-2cm per week 9. **At what gestational age is a pregnancy considered term?** q. 37 weeks