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OB Fetal Assessment
Normal Pregnancy and Fetal Assessment
| Question | Answer |
|---|---|
| How soon after fertilization can pregnancy be detected? | 12-15 days |
| EDD | Expected Date of Delivery |
| hCG in the first 12 weeks | in a normal pregnancy, the hCG doubles every 48 hours. If this doesn't happen, think of an ectopic pregnancy. After 1st trimester, hCG levels off |
| Very high hCG may suggest a | molar pregnancy/gestational trophoblastic dz |
| Loss of fetus before 22 weeks is called | miscarriage |
| Loss of fetus after 22 weeks is called a | stillbirth |
| Embryonal Stage | 0-10 weeks |
| Body water increase in Pregnancy | 6.5-8.6 L: Fetus, placenta and amniotic fluid accounts for 3.5 L, Maternal blood volume 1.5-1.6, Extravascular fluid |
| Cause of anemia in pregnancy | hemodilution, not iron deficiency. This extra fluid contributes to elevation in maternal cardiac output 30-50% |
| MBP in pregnancy | decreases as a result of SVR (due to progesterone) |
| Maternal Left ventricle heart change | Increase in left ventricular end-diastolic dimension given the increase in volume |
| What decreases in pregnancy? | SVR, Pulmonary Vascular Resistance, Oncotic pressure |
| Most common complaint in pregnancy prior to 20 weeks | Dyspnea. Benign if occurs early in pregnancy and does not worsen |
| Normal changes in pregnancy that can mimic heart disease: | Dyspnea, decreased exercise tolerance, fatigue, occasional orthopnea, and chest discomfort, edema. Not nl sx: syncope, chest pain with exertion, progressive orthopnea, hemoptysis. |
| Upper respiratory changes in Pregnancy | hyperemic and edematous nasopharynx mucosa, hypersecretion of mucous, marked nasal stuffiness. Saline spray works very well, allergy meds will not work |
| Lung volume and pulmonary function in Pregnancy | elevation in diaphragm decreases lung volume (5%), Max volume that can be inhaled increases (5-10%), Hyperventilation (mom will breathe more and take in less each time) |
| Gas exchange in Pregnancy | Decrease in PaCO2, Increased CO2 gradient between fetus and mother allows transfer of CO2 from fetus to mom. Chronic respiratory alkalosis. Renal compensation for drop in PaCO2 --> increase in bicarbonate excretion |
| Hematologic changes in Pregnancy | Dilutional anemia, maintain iron levels to absorb 3.5mg/day (recommend 325 Fe), Decreased platelets, WBC increases, Hypercoaguable state (body is designed like this so that when a woman gives birth, she won't exsanguinate and die) |
| Urinary Tract Changes in Pregnancy | Kidneys enlarge, Ureters may dilate, increased incidence of pyelo (test and tx asx bacteriuria), bladder capacity decreases due to enlarging fetus (causing increased frequency and incontinence) |
| Hemodynamics in Pregnancy | Renal Plasma flow increases; reduction in creatinine, BUN and uric acid |
| Tubular Fxn in Pregnancy | Glucose excretion increases (repetitive glycosuria-->screen for DM), increase exertion of aminoacids, calcium and bicarb, no increase in proteinuria |
| Appetite changes | increases about 200 kcal/day. NOT EATING FOR TWO! |
| Stomach changes in Pregnancy | Tone and motility decreases due to progesterone, increase incidence of GERD |
| Intestinal changes in Pregnancy | Increased constipation, shifted location of apppendix, portal venous pressure increases, Varices |
| Nausea and Vomiting | Complicates 70% of pregnancies, onset 4-8 wks improvement by 14-16wks, seldom leads to sig. weight loss |
| Tx of N/V | Largely supportive, reassurance, avoid triggers, frequent small meals, Acupressure with wristbands, ginger, Vit. B6 |
| Hyperemesis Gravidarum | Associated with weight loss,ketonuria,dehydration, and electrolyte imbalance (need to admit for these signs). r/o pancreatitis, cholecystitis, hepatitis, thyroid dz. IV fluids, Antiemetics, Methylprednisolone (if refractory to antiemetics), tube feed |
| Glucose | Peripheral resistance to insulin (max in 3rd trimester), due primarily to hPL (human placental lactogen), results in hyperglycemia and hyperinsulinemia |
| Fats/Lipids | Plasma lipids and lipoproteins increase. Total Cholesterol and LDL increase by 50-60% from nonpregnant |
| Skin Changes | Hyperpigmentation, linea alba becomes linea nigra, pigmented nevi, freckles, and recent scars. Straie affect up to 90% and appear in late trimester |
| Hair changes | mild degree of hirsutism common due to placental androgen production and elevated levels of cortisol |
| Weight gain in pregnancy | depends on your current BMI. Anywhere from 15-45 lbs. A woman with a nl BMI of 20-24 should gain 25-35 lbs |
| Where does the weight go in pregnancy? | Baby: 7.5lbs, Breasts: 2lbs, Body fat and storage : 7lbs (hard to lose), Placenta: 1.5 lbs, Uterine growth:2lbs, Amniotic fluid: 2lbs, Blood: 4lbs, Body fluids: 4lbs |
| Placenta location | outside the amniotic sac. |
| Differences between the Fetal Circulatory System and the adult circulatory system | Fetal blood has about a 50% higher concentration of Hgb than maternal blood. Can carry 20-30% more O2 than maternal blood |
| Umbilical cord vein and artery function | Umbilical vein brings all of the O2 and nutrients to the placenta for the baby; the umbilical arteries take all waste and C)2 back to mom for her to filter |
| 3 Shortcuts of Fetal Circulation that occur for baby to maximize O2 intake: | Ductus venosus, Foramen Ovale, Ductus arteriosis |
| Ductus Venosis | umbilical vein brings O2 from mom. Bypass in the liver, oxygenated blood will bypass the liver and go immediately into the baby’s heart. Enters the baby’s heart from IVC into the right atrium. |
| Foramen Ovale | Btwn right atrium and left atrium, another bypass called foramen ovale. Now oxygenated blood goes from R atrium to L atrium. Then to aorta and to brain. |
| Ductus Arteriosus | bridge that occurs in descending aorta/pulmonary veins – now oxygenated blood can get into the lower extremity of the baby |
| ________allows blood to flow from the pulmonary trunk to the descending portion of the aorta to keep blood out of the lungs and from damaging lung capillaries. | Ductus Arteriosus |
| The foramen ovale is sealed shut by the change in atrial pressure, and becomes the fossa ovalis | Closes immediately after baby takes first breath. Lots of pressure forms in lungs w/ this breath, pressure goes into L atrium and builds up and closes the opening. |
| Both the ductus arteriosus and the ductus venosum are closed by sphincter muscles and get turned into ligaments. | If woman takes lots of NSAIDs during pregnancy, will lead to closure of this shunt. Prostaglandins keeps this open. |
| To avoid Listeriosis, tell your patient to | Not eat: unpasteurized milk or soft cheeses, rwa or undercooked meat, poultry, shellfish. Processed meats, unless reheated |
Created by:
ltm12