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Antepartum

Childbearing

TermDefinition
GTPAL Gravida, Term, Preterm, Abortion, Living Children
Signs of Pregnancy Amenorrhea,n&v, fatigue, increased urination, breast&skin changes, quickening
Chadwick's sign Cervix turns blue/purple
Goodell's Sign Softening of cervix
Hegar's sign Softening of lower uterine segment
Ballottment Push and baby floats up and back down
Leopold's movement palpation of fetal movement
Pregnancy test Measures HCG levels (cause n&v)
McDonald's Movement Measures uterine enlargement (pubic symphasis to top of funds) 8weeks = 8 cm
Nagele's Rule First day of last menstrual period (LMP) - 3 months + 7 days = EDD, EDC
Positive signs of pregnancy Auscultation of heart sounds (fetoscope/Doppler), fetal movement felt by examiner, visualization of fetus
Pregnancy length 10 months, 40 weeks, 280 days
Oogenesis Oocyte mature and located in graafian follicle
Progesterone Relaxes smooth muscle and allows for planting
Cortical Reaction Prevents other sperm from entering
3 days Time to travel from ovary to uterus
Preembryonic Stage First 14 days of development (Cleavage-Blastomeres from Modula - blastocyst-trophoblast)
Blastocyst Develops into embryonic disc and amnion
Trophoblast Develops into chorion
Fraternal Twins Two oval and two sperm - dizygotic
Identical Single fertilized ovum - monozygotic
Implantation 7-10 days after fertilization, blastocyst burrows into endometrium. Now called embryo and endometrium called decidua
Primary germ layers Ectoderm, mesoderm, endoderm
Ectoderm Forms brain and CNS
Mesoderm Forms bones, CT, heart, and BVs
3rd gestational week Heart begins to form
4th gestational week Heart begins to beat and circulate
Endoderm GI and Respiratory systems
Fetal movement can be felt by examiner
Tetragons Smoking, drinking, and other toxic influences
Chorion First embryonic membrane to form, develops from trophoblast and will change into placenta
Amniotic fluid In amnion, Neutral temp. Environment, allows for symmetrical growth, and space for fetal movement, cushions, space for umbilical cord
Umbilical cord Provides circulatory pathway from chronic villi to embryo; 2 arteries carry deoxygenated blood and vein carries oxygenated blood
Yolk Sac 8-9 days after conception, forms primitive blood cells and becomes part of umbilical cord
Wharton's Jelly A gelatinous substance that provides insulation and protection within the umbilical cord
Placenta Place of metabolic and nutrient exchange
Duncan "dirty" Maternal portion - Attaches to uterus
Shultz "shiny" Fetal portion
9 weeks Considered fetus
10 weeks Placenta takes over function
Placental function Gas exchange, nutrient exchange, Endocrine functions (decrease HCG, Human Placental Lactogen (ensures proteins, glucose, and minerals available) estrogen (enlargement of tissues in mom) progesterone (relaxes smooth muscles)
Fetal Stage 9 Week's to birth; every organ system, structure present, gestation time to refine structures and perfecting function
8-12 Weeks Males begin producing testosterone
24 weeks Viability (decent chance of fetus surviving) begin seeing breathing on ultrasound (swallowing amniotic fluid- will form mirconium)
28 weeks Lungs better able to have gas exchange
36 Week's Lanugo begins to disappear
Early pregnancy Nutritional deficiencies with cellular division causes permanent fetal damage
Late pregnancy Nutritional deficiencies lead to problems with low birth weight
1st Trimester Doesn't need to increase calories
13 weeks through delivery (2nd and third trimester) increase 300 calories/day
Folacin/Folic Acid 600mcg/day; green veggies, liver, peanuts, whole grains
Folacin Deficiencies Leads to neural tube defects (such as spina bifida)
Iron Take with food to reduce nausea, take with acidic beverage (OJ), don't take w/ milk, antacids, or caffeine
Sodium Causes fluid retention, caution with edema, b/c indicates preeclampsia, may need some extra sodium in order to keep water in cell because lack of sodium will dehydrate
Maternal Weight Gain 22-28lbs
Underweight 28-40lbs (<18.5)
1-6 months Fetus dependent on what mom eats
Normal 25-35lbs BMI 18.5-24.9
Overweight 15-25lbs BMI 25-29.9
Obese 11-20lbs BMI >30
1 Trimester 2-4lbs
2&3 Trimester ~1lb/week
35lbs Optimal pregnant teen weight gain
Fluid Retention >2lbs/week (abnormal swelling)
Caffeine Restrict to 200mg/day
Hyperemesis Gravdarum Constant vomiting - can't even keep water down - r/t hormone changes and allergic rxn to fetal proteins
GA 39 1/7 = 39 weeks and 1 day
Gravida How many times pregnant (includes abortions, miscarriages, current)
Para How many delivered over 20 weeks
Term How many past 37 weeks
Stillborn Born w/o heart beat after 20 weeks
LC Living
gravida 3 - Para 2 Ex: 3/2
Shark, shrimp, crab, tuna SaltH2O fish to avoid
Breast changes Increase size and darker nipples due to progesterone, estrogen, and lactin
Mucous plug Prevents organisms from entering
1/month until 28 weeks, q2weeks until 36th week, qweek until labor How often for visits during pregnancy
3 father phases Announcement, moratorium, focusing
Couvade syndrome Partner may experience pregnancy symptoms and discomforts to pregnant partner
3rd trimester Sexual desire increases
Fetal Fibronectin (FFN) Glycoprotein; Presence between 20-34 weeks (strong indicator of pre-term delivery in next 2 weeks)
Dehydration, sex, recent cervix check Can cause pre-term labor
Betamethazone Corticosteroid given to stop pre-term delivery (2 doses IM 24h apart)
Rehydrate, Betamethazone, Mg Sulfate, Turbuteline, Antiobiotics Tx of Preterm Labor
Magnesium Sulfate Given 4-6 grams initially then 2g/h IV to relax smooth muscle and cease contractions (5-7 magnesium levels = therapeutic)
Magnesium Sulfate Toxicity Decreased reflexes, respirations, urinary output
Magnesium sulfate side effects n&v, weakness, just "feel bad all over", sweaty
Turbuteline Relaxes smooth muscle of uterus and bronchodilator given SubQ
Antibiotics Proactive since don't have group beta strip tests
Premature Rupture of Membranes Rupture before 37 weeks
Incompetent Cervix Painless cervical dilation in 2nd trimester
Preeclampsia Progressive disorder that occurs after 20 weeks gestation (usually in last 10 w, during labor, or first 48h after birth) Proteinuria present
Eclampsia Seizure in the presence of preeclampsia
Chorionic Villus Sampling (CVS) Sample of chorionic villi from the edge of the placenta
Amniocentesis Needle inserted into the uterine cavity through maternal abdomen
Mature Lungs Lecithin/Sphingomyelin ratio >2:1
Immature Lungs L/S ration <2.1
Alpha-fetoprotein (AFP) Fetal serum protein present in maternal serum and amniotic fluid (maternal serum AFP peaks @ 30w; Amniotic peaks @15w)
Quad Screen Can predict neural tube defects/down syndrome, estriol, hCG, inhibin A (hormone)
Abnormality Present Low MSAFP and estriol
Trisomy 21 High levels of HCG and inhibin A
Neural Tube Defect Decreased estriol
Daily Fetal Movement Count (DFMC) Kick count
Amniotic Fluid Index (AFI) Amount of amniotic fluid in uterus is an indicator of fetal well-being (kidneys are being perfused)
NonStress Test Requires fetal monitor and observe for accelerations of fetal heart rate in response to fetal movement
Reactive NST 2 or more accelerations of FHR w/n 20m
Nonreactive NST <2 accelerations of FHR w/n 20m
Contraction Stress Test (CST) Used in @risk pregnancies (nonreactive NST & post dates) observe response of FHR to contractions
Negative CST No late decelerations occur after any contraction
Positive CST Late decelerations occur w/ @least 2/3 contractions
Equivocal Late decelerations w/ a single contraction
Biophysical Profile (BPP) Fetal breathing movements, gross body movements, fetal tone, reactive FHR, amniotic fluid volume (2pts/criteria=10pts)
Fetal OH Syndrome Damage Degrees 1- CNS damage 2- facial malformations 3-growth retardation
Crystal Meth During Pregnancy The Walk Away Drug
<11 Iron 1st & 3rd trimester
<10 Iron 2nd trimester
Placenta Accreta serious pregnancy condition that occurs when blood vessels and other parts of the placenta grow too deeply into the uterine wall.
Chromosomal Abnormalities #1 Reason for abortions
Ectopic Pregnancy Embryo implanted outside uterine cavity; most often in fallopian tube
Ectopic Drug Therapy Methotrexate (dissolves embryo but preserves fallopian tube)
Hydatidiform Mole Non-viable pregnancy in which sperm duplicates on itself or 2 sperm fertilize 1 egg
Hydatidiform Mole hCG extremely elevated; monitor levels for 1 year after incident
Placenta Previa e placenta is located low in the uterus. The placenta might partially or completely cover the cervix
Abruptio Placenta placenta peels away from the inner wall of the uterus before delivery
HELLP Syndrome Hemolysis, Elevated Liver enzymes, Low Platelets
Preeclampsia Only cure is birth of fetus and removal of placenta
Created by: TedMed