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L&D MT 1

human gestation period 40 weeks plus or minus 2
first trimester (weeks) 0-13
second trimester (weeks) 13-26
third trimester (weeks) 26-
preterm before 37 weeks
term 37 weeks
post term 42 weeks
nagele's rule LMP subtract 3 months, add 7 days
gravidity pregnancy
gravida a pregnant woman
primigravida pregnant for first time
multigravida two or more pregnancies
parity number of viable pregnancies (past 24 weeks)
nullipara no pregancies reaching viability
multipara two or more pregnancies reaching viability
GTPAL: G total number of pregnancies (including present pregnancy)
GTPAL: T total number of pregnancies to term
GTPAL: P total number of preterm pregnancies
GTPAL: A total number of abortions
GTPAL: L total number of living children
presumptive signs of pregnancy what mom says; amenorrhea, physiologic changes, breast tenderness, morning sickness, emotional symptoms/mood swings
probable signs of pregnancy what examiner sees; uterine enlargement, chadwick's sign, hegars sign. braxton hicks contractions
chadwicks sign violet-bluish vaginal mucosa and cervix caused by increased vascularity (occurs by 6-8 weeks)
hegars sign softening and compressibility of the lower uterine segment (uterine isthmus) (approx 6 weeks)
braxton hicks contractions irregular and painless contractions that occur at 16-18 weeks and throughout pregnancy. Facilitate uterine flow through placenta
positive signs of pregnancy deal with baby; fetal heart rate, fetal movement, visualization of fetus
When should first prenatal visit be? soon after first missed period
prenatal visits: timing once a month until 32 weeks every 2 weeks until 36 weeks every week until delivery
Prenatal screening health history, family history, genetic disorder, emotional/psychological, social/economic, cultural/religious, complete physical assessment, vital signs, assess for onset of problems, pelvic exam, lab tests, education
prenatal lab tests HBsAg, glucose, CBC, RPR, blood type, Rh factor, ppd skin test, HIV
gestational hypertension (PIH) onset of hypertension without proteinuria after week 20 of pregnancy
chronic hypertension hypertension that is present before the pregnancy or develops before 20 weeks of gestation (or last longer than 6 weeks PP)
preeclampsia pregnancy specific condition of hypertension and proteinuria after 20 weeks in a previously normotensive woman
HELLP syndrome variant of severe preeclampsia that involves hepatic dysfunction : Hemolysis, Elevated liver enzymes, Low Platelets
TORCH infections: T toxoplasmosis
toxoplasmosis protozoal infection from raw meats and cat litter. Gives mom influenza like symptoms, gives baby injury/miscarriage in 1st trimester or congenital infection in 3rd trimester
TORCH: O other: syphilis, varicella, GBS, HIV, hep
TORCH: R rubella
Rubella viral infection, spread by droplets; rash, muscle aches, joint pain, lymphedema in mom, miscarriage, anomalies, death in baby
TORCH: C cytomegalovirus
Cytomegalovirus herpesvirus, spread through contact. Asymptomatic/mild influenza in mom, microcephaly, eye, ear, dental effects, mental retardation in baby
Herpes Simplex Virus STI, infection through birth canal. Painful blisters, tender lymph nodes, fever, viral meningitis in mom, risk for fetus late/during delivery
Rh Factor D antigen present on RBC or not
RH isoimmunization Rh- mom has Rh+ fetus, mom is exposed to fetal Rh+ antigens and makes primary response antibodies. Mom becomes exposed to Rh+ antigen again in next pregnancy and this produces lots of IgG that crosses placenta and causes fetal agglutination/hemolysis
Rho IgG (RhoGam) acts to suppress antibody formation, prevents isoimmunization (protection lasts 12 weeks)
Purposes of adaptations to pregnancy 1) to protect women's normal physiologic functioning, meet metabolic demands of pregnancy, and provide for fetal development and growth
Changes in uterus size result of estrogen/progesterone; early enlargement r/t increased vascularity, dilation of blood vessels, hyperplasia, hypertrophy, decidua; later enlargement r/t mechanical pressure of fetus
Changes in uterine shape becomes more spherical/globular in second trimester, later becomes ovoid
changes in uterine position 12-14 weeks: symphysis pubis 22-24 weeks: umbilicus term: almost to xiphoid process 38-40 weeks: fundal height drops as fetus begins to descend and engage in pelvis
ballottement passive movement of unengaged fetus (16-18 weeks)
quickening feel baby move, flutter, then becomes more frequnt and intense (16-18 weeks)
vagina and vulva changes mucosa thickens, connective tissue loosens, smooth muscle hypertrophy, vaginal vault lengthens
leukorrhea white or slightly gray mucoid discharge with faint musty odor. Occurs in response to cervical stimulatin by estrogen and progesterone (forms mucus plug)
changes in breasts fullness, heightened sensitivity, tingling, heaviness of breasts, nipples/areola become more pigmented, 2nd and 3rd trimester starts growth of mammary glands (lactation inhibited until decrease in estrogen occurs after birth)
montgomery's tubercles hypertrophy of sebaceous glands in primary areolae
colostrum creamy white to yellowish to orange premilk fluid
blood pressure changes usually stays around the same, can get lower (especially with supine position)
supine hypotensive syndrome compression of vena cava when mom is in supine position causes hypotension
reasons for varicosities, dependent edema, and hemorrhoids in pregnancy compression of iliac veins and inferior vena cava by uterus increase venous pressure and reduce blood flow in legs
blood volume during pregnancy increases approximately 40-45% (1500 ml), essential for meeting needs of hypertrophied vascular system, hydrating tissues, and fluid reserve (peripheral vasodilation)
physiologic anemia during pregnancy since plasma increases faster than RBCs, there is hemodilution and less H&H
What does cardiac output do during pregnancy? increases
circulation time during pregnancy decreases by week 32, normal by term
coagulation during pregnancy increases clotting factors increases risk for coagulation
basal metabolic rate during pregnancy increases during pregnancy because of increased oxygen demand and consumption
renal system anatomic changes hormonal activity, pressure from uterus, increase in blood volume, bladder displaced upward to abdomen
urine stasis/stagnation during pregnancy Pelves and ureters hypertrophy and dilate: larger volume of urine held in pelves and ureters, urine flow rate is slowed ; Bladder irritability, nocturia, urinary frequency/urgency
functional changes in renal system GFR and renal plasma flow increases (due to pregnancy hormones, increased blood volume, posture, physical activity, nutritional intake)
positon that promotes best renal function lateral recumbent position
position withleast efficient renal function supine; compresses aorta and vena cava and decreases cardiac output
How do the kidneys prevent sodium depletion during pregnancy? increased tubular reabsorption
physiologic/dependent edema pooling of fluid in lower legs lowers GFR and renal blood flow in late pregnancy
cholasma facial melasma, "mask of pregnancy", blotchy, brownish hyperpigmentation of skin over the cheeks, nose, and forehead
linea nigra pigmented line extending from symphysis pubis to the top of the fundus in midline
striae gravidarum stretch marks, cause by separation of connective tissue
palmar erythema pinkish red diffuse mottling or well defined blotches on palmar surfaces of hands
Why does the spinal curvature realign during pregnancy? increased weight, decreased abdominal tone and abdominal distention
lordosis increase in lumbosacral curve (compensatory curvature in cervicodorsal region, exagerrated anterior flexion of the head)
musculoskeletal changes in pregnancy lordosis, relaxation and increased mobility of pelvic joints, decreased abdominal muscle tone, maay have separation of rectus abdominus
neurologic changes in pregnancy hypothalamic-pituitary neurohormonal changes, sensory changes in legs r/t compression, traction of nerves r/t lordosis, carpal tunnel syndrome, numbness/tingling of hands, tension headache, light headedness,, syncope, postural hypotension
appetite during pregnancy morning sickness r/t increased hCG and altered carb metabolism, cravings and changes in dietary intake, pica
mouth during pregnancy hyperemic spongy swollen gums, bleeding gums (estrogen increases vascularity)
epulis red, raised nodule on gums that bleeds easily
ptyalism excessive salivation
hiatial hernia stomach herniates into diaphragm, happens in 15-20% of pregnancies
Cause of heartburn in pregnancy increased progesterone causes loss of muscle tone, which causes esophageal regurgitation, slower emptying of stomach, reverse peristalsis
Iron absorption during pregnancy increases
why does constipation occur during pregnancy? increased progesterone cause decrease in muscle tone, which causes increase in water absorption and constipation
gallstones during pregnancy decreased muscle tone (progesterone), distended, increased emptying time, thickening of bile due to prolonged retention, hypercholesterolemia
intrahepatic cholestasis retention and accumulation of bile in liver, occurs late in pregnancy, may result in itchiness
abdominal discomfort during pregnancy pelvic heaviness, pressure, round ligament tension, flatulence, distention, bowel cramping, uterine contractions
pituitary and placental hormones (after fertilization) elevated levels of estrogen and progesterone suppress FSH and LH, after implantation, fertilized ovum and chorionic villi produce hCG which maintains production of estrogen and progesterone by the corpus luteum until the placenta takes over
prolactin responsible for lactation, estrogen and progesterone inhibit lactation by blocking binding of prolactin to breast tissue until after birth
oxytocin causes uterine contractions (prevented by progesterone levels until birth)
human chorionic somatomammotropin (hCS) produced by placenta, acts as growth hormone and contributes to breast development
progesterone essential for maintaining pregnancy by relaxing smooth muscles, resulting in decreased uterine contracitlity and prevention of miscarriage
estrogen enlargement of genital, uterus,breasts, increases vascularity, vasodilation, relaxes pelvis, alters metabolism of nutrients- interferes with folic acid metabolism, increasing total body proteins, promoting retention of Na and H20 by kidney, decreases HCL
Labor process of moving fetus, placenta, and membranes out of the uterus and through the birth canal
signs preceding labor lightening, bloody show
lightening fetus' presenting part descends into the true pelvis ("dropping")
bloody show brownish or blood tinged cervical mucus
oxytocin stimulation theory uterine distention stimulates release of oxytocin, which stimulates the uterus to contract
progesterone deprivation theory as level of oxytocin increases, progesterone decreases an uterus contracts
organ communication system theory as stomach grows, uterus compresses other organs, sends body into labor
first stage of labor lasts from onset of regular contractions to dilation to 10 cm and effacement to 100%
early/latent phase of labor 0-3 cm, mild contractions, effacement progresses
active phase of labor 4-7 cm, contractions more intense, usually ask for meds at this point, more rapid dilation and descent
transition phase of labor 8-10 cm, very strong contractions close together
second stage of labor last from when the cervix is fully effaced and dilated until the birth of the fetus (pushing phase)
third stage of labor delivery of placenta
fourth stage of labor 1-2 hours after delivery of placenta, immediate recovery
Factors affecting the labor process (5 P's) passenger, passageway, powers, position, psychological response
fetal head bones 2 parietal, 2 temporal, frontal and occipital bones joined by sutures
fontanels membrane filled spaces located where sutures intersect
anterior larger, diamond shaped
posterior triangular
fetal presentation refers to what part of the fetus that enters the pelvis inlet first and leads through the brith canal during labor
presenting part part of the fetus that lies closest to the internal os
cephalic head first (vertex)
breech buttocls, feet, or both first
shoulder presentation scapula is presenting part
fetal lie the relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother
longitudinal lie (vertical) baby spine is parallel to mom spine
transverse lie (horizontal) baby spine is perpendicular to mom spine
fetal attitude relationship of fetal body parts to each other - normally general flexion
fetal position the relationship to a reference point on the presenting part (occiput, sacrum, mentum, sinciput) to the 4 quadrants of the mother's pelvis
fetal position- first letter location of presenting part to the right or left side of mothers pelvis
fetal position- second letter stands for specific presenting part of the fetus
fetal position- third letter location of the presenting part in relation to anterior, posteriorm or transverse portion of maternal pelvis
station the relationship of the presenting part to an imaginary line drawn between maternal ischial spines- measures degree of descent of presenting part through birth canal, measured in cm above/bleow ischial spines (level of spines = 0)
passageway (birth canal) 1) bony pelvis 2) soft tissues: uterus, cervix, pelvic floor muscles, vagina, introitus
powers contribute to expel fetus and placenta from uterus
primary powers involuntary uterine contractins (measured in frequency, duration, intensity), dilation and effacement
dilation enlargement or widening of the cervical opening ad cervical canal
effacement shortening and thinning of the cervix during the first stage of labor
secondary powers bearing down efforts (pushing)
Position changes in labor- purposes relieve fatigue, increase comfort, improve circulation, aid fetal descent
position that promotes descent/ affect gravity UPRIGHT- gravoty promotes descent, beneficial to cardiac output, compression prevented
all fours position relieve back pain, may anteriorly rotate fetus
lithotomy physician attended births
semirecumbent need adequate body support to push effectively because weight is on sacrum, causing reduction in pelvic inlet
sitting/squatting abs work in synchrony with contractins during bearing down efforts
kneeling moves uterus forward, aligns fetus with inlet, increases outlet
lateral position can help rotate fetus in posterior position
psychologic response state of mind, patterns of coping with stress and anxiety, past labor experiences, attitudes
7 Cardinal Movements of Labor engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
engagement the transverse diameter of the presenting part (biparietal diameter) has passed through the maternal pelvic brim or inlet into the true pelvis (station 0)
gate control theory brain can only get so much info at a time, cant concentrate on 2 thigns at once
Lamaze method focused breathing, movement and massage, gives women confidence in ability to give birth
Grantly Dick Read method blocks fear and tension pain cycle
bradley method husband coached
effleurage light stroking, usually of abdomen in rhythm with breathing during contractions
counterpressure steady pressure applied by a support person to the sacral area with a firm object (fist, heel of hand)
sedatives relieve anxiety and induce sleep- phenergan, vistaril, reglan, zofran, valium, ativan
opioid agonist analgesics dilaudid, demerol, fentanyl (shorter acting), sufentanil... only blunt the perception of pain, dont eliminate it, cause respiratory depression
opioid agonist-antagonist analgesics stadol and nubain; less respiratory depression, more effective pain relief, but have longer half life
opioid antagonists Narcan; reverse depressant effects, especially respiratory depression- can be given to mom and baby
local perineal infiltration usually idocaine chloroprocaine--> used for episiotomy or repairs of lacerations in women without regional anesthesia
pudendal nerve block relieves pain in lower vagina, vulva, and perineum (used in late second stage for episiotomies or repairs)
spinal anesthesia anesthetic into 3rd, 4th or 5th lumbar interspace into subarachnoid space- anesthesia from nipple to feet (used for C-sections)
epidural anesthesia inject local anesthetic, opioid or both into epidural space (T10-S5)
Contraindications to subarachnoid and epidural blocks risk for hemorrhage, hypotension, coagulopathy
timing of pharm. management no opioids past 7 cm
Created by: alexadianna