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OB Tutoring
Pregnancy
| Term | Definition |
|---|---|
| Intrauterine Development: Pregnancy Development | Preembryonic Stage (Fertilization to Week 2) - The fertilized ovum becomes a morula and then a blastocyst before entering the uterus. Embryonic Stage (Weeks 2 - 8) - Organs, the Body Begins to Develop - Fetal Stage (Weeks 9 - 38+) |
| Intrauterine Development (Embryonic Stage) | Week 2: - Implantation occurs (when the fertilized egg attaches to the uterine lining) - Fertilized Egg Attaches to Uterine Lining |
| Intrauterine Development (Embryonic Stage) | Week 3: - Neural Tube Fuses (Structure in Which the Brain and Spinal Cord Form) - Tubular Heart Begins to Beat |
| Intrauterine Development (Embryonic Stage) | Week 4: - Respiratory & Digestive Tracts Begin to Form - Neural Tube Fusion Complete - Neural Tube Defects are the Most Common During the First 4 Weeks |
| Intrauterine Development (Embryonic Stage) | Week 5: - Limbs Bud Week 6: - Heart in Final Form Week 8: - First Brain Waves Detectable |
| Intrauterine Development (Fetal Stage) | Weeks 9 - 12: - Fetal Movement Begins - Kidneys Begin to Function - Genitalia Fully Differentiated |
| Intrauterine Development (Fetal Stage) | Week 13 - 16: - Oogenesis is established (female) - Blood Vessels Visible Under Skin - Ridges in Handprints, Footprints, Fingers, Toes |
| Intrauterine Development (Fetal Stage) | Week 20: - Swallowing Present - Insulin Production Begins - Lanugo (soft, fine hair covering a fetus while inside the uterus) & Vernix Caseosa (a white, waxy substance that covers a fetus's skin during the last trimester of pregnancy) Cover Body |
| Intrauterine Development (Fetal Stage) | Week 24: - Surfactant Forms (Lungs) - Helps Keep Alveoli Open and Prevents Lung Collapse Week 28: - Testes Descend - Head Down Position (Often) - Blood Produced in Bone Marrow |
| Intrauterine Development (Fetal Stage) | Weeks 29 - 34: - Subcutaneous Fat Deposits Begin - CNS Maturity → Fetal Heart Rate Variability More Pronounced |
| Intrauterine Development (Fetal Stage) | Weeks 33 - 38: - Visual Acuity 20/600 - A fetus can only see what a person with normal vision could see at a distance of 20 feet, at 600 feet. - Vernix Only in Skin Creases |
| Intrauterine Development (Fetal Stage) | Weeks 33 - 38: - Lanugo Only on the Upper Back and Shoulders - Lungs and CNS Mature - Fetus Grows and Gains Weight |
| Placenta | - A temporary organ forms in the womb and acts as a circulatory system between the gestational parent and the embryo/fetus. - Fetal Surface - Smooth, Shiny, Translucent - Maternal Side - Meaty, Red Appearance |
| Placenta | Arteriovenous anastomosis (AVA) is a structure in the placenta that connects arteries and veins: - Two Arteries and One Vein in the Umbilical Cord - The Vein Brings Oxygenated Blood & Nutrients to the Baby - Arteries Carry Away Waste from the Baby |
| Placenta | - Serves three primary functions: circulation, protection, and hormone production - The placenta secretes hormones to support the pregnancy. |
| Umbilical Cord | - On the fetal side of the placenta - Contains one large vein that carries oxygenated blood to the embryo/fetus and two smaller arteries that carry deoxygenated blood to the placenta. - Often appears twisted, likely from fetal movement. |
| Umbilical Cord | - The umbilical cord is covered in Wharton's jelly, which helps support and protect vessels |
| Body System Changes (Respiratory) | - Increased Oxygen Consumption - Mild Hyperventilation - Dyspnea is Normal - Physiological Respiratory Alkalosis - Diaphragm Elevates |
| Body System Changes (Respiratory) | - Ribs Expand - Subcostal Angle Increases - Increased Estrogen - May Cause Swelling of Pharynx, Trachea, Larynx - May Have Frequent Nose Bleeds |
| Body System Changes (Cardiovascular) | - White Blood Cells Increase in the Second & Third Trimester - Increased Clotting Factors - High Risk to Develop Clots - Slight Cardiac Hypertrophy - Increased Pulse (10 - 15 bpm) |
| Body System Changes (Cardiovascular) | Blood Pressure: - First Trimester - Normal - Second Trimester - Decreased BP is Expected - Third Trimester - Normal - If BP Increases Instead of Decreasing in the Second Trimester there is a Concern about Preeclampsia and Eclampsia. |
| Body System Changes (Cardiovascular) | - Increased Cardiac Output (as much as 50%) - Increased Blood Volume - Hemodilution Causes Physiological Anemia |
| Body System Changes (Reproductive) | - Breasts Grown for Breastfeeding - Week 12: Colostrum Production - Braxton Hicks Contractions May Occur - Mucus Plug Forms in the Cervical Canal - Protects Fetus from Pathogens - Increased Estrogen |
| Body System Changes (Reproductive) | Measure Size of Uterus - From Fundus to Symphysis Pubis - # of Weeks Gestation = # in cm - 36 Weeks = 36 cm - 16 Weeks = 16 cm |
| Body System Changes (Reproductive) | Measure Size of Uterus - From Fundus to Symphysis Pubis - From 16 - 36 Weeks a Vertex, Singleton Presentation will have a Fundal Height in centimeters that Corresponds to Weeks Gestation |
| Body System Changes (Reproductive) | Increased Vascularity of the Vulva, Vagina, and Cervix - Vaginal pH may be Acidic - Protects Against Bacteria Milky, Clear Discharge is Normal |
| Body System Changes (Genitourinary) | - Increased Blood Flow to Kidneys - Increased Glomerular Filtration Rate - Excretion of Fetal Waste - Slight Glycosuria and Proteinuria Possible - Increased Sodium and Water Reabsorption |
| Body System Changes (Musculoskeletal) | Lordosis Forms Due to Shift in Gravity - Increased Risk of Falls Relaxin and Progesterone Increased Mobility but Makes Less Stable Joints - Round Ligament can Stabilize the Uterus can Stretch and Cause Pain |
| Body System Changes (Musculoskeletal) | Diastasis Recti - Muscles of the Abdomen Separate |
| Body System Changes (Gastrointestinal) | Reduced Peristalsis and Delayed Gastric Emptying - Heartburn - Constipation - Gallstones Increased Metabolic Rate - Increased Caloric Demand |
| Body System Changes (Miscellaneous) | Skin Changes (Most Bothersome as they are the Most Obvious) - Linea Nigra - Stretch Marks Mom Supplies Thyroid Hormones Until Week 12 Insulin Needs Increase Steadily During the Second Trimester - Insulin Does Not Cross the Placenta |
| Body System Changes (Miscellaneous) | Oxytocin - Stimulates Contraction - Milk Ejection Cortisol Levels Increase in the Second Trimester - Promotes Lung and Neuro Development |
| Weight Gain | - Low BMI: 28 - 40 lbs - Healthy BMI: 25 - 35 lbs - Overweight BMI: 15 - 25 lbs - Obese BMI: 11 - 20 lbs |
| Weight Gain | Too Much Weight Gain - Pregnancy Induced Hypertension - Macrosomia - Risk for C-Section Too Little Weight Gain - Small for Gestational Age (SGA) Baby Do Not Diet During Pregnancy - Risk for Ketoacidosis |
| Nutrition Issues | Anemia - Iron Supplementation May be Recommended - PICA (craving ice/dirt/non-food items is common) Fetal Neural Tube Defects - Folic Acid Supplementation Additional 300 kcals/day Increase Protein for Fetal Growth Limit Caffeine NO ALCOHOL |
| Nutrition Issues | Avoid: - Fish - Deli Meat - Soft Cheese - Hot Dogs - Unpasteurized Milk - Smoked Seafood |
| Exercise | Should Encourage Moderate Exercise - Improves Muscle Tone - Shorten Course of Labor - Greater Sense of Wellbeing Dehydration can Trigger Premature Labor Walking is the Best (Low Impact & Intensity) |
| Exercise | - Runners can Run until they can NO LONGER Tolerate it - Liberal Amounts of Fluid Intake Before, During, and After Exercise - Need Sufficient Caloric Intake to Meet the Demands of Both Pregnancy and Exercise |
| Discomforts in Pregnancy | Fatigue - Encourage napping or resting when possible. Lightheadedness - Sit/Stand slowly Nasal Congestion or Nosebleeds - Saline nasal sprays or humidifiers |
| Discomforts in Pregnancy | Dyspnea - Encourage improved posture to increase lung expansion. - Light exercise & stretching to help alleviate the heaviness of breathlessness. |
| Discomforts in Pregnancy | Edema - Light exercise, avoid long periods of sitting and standing, and elevate legs when possible. - Temporary carpal tunnel syndrome due to edema around nerves in the wrist |
| Discomforts in Pregnancy | Supine Hypotension - Enlarged uterus compresses the IVC and the abdominal aorta, this compression reduces venous return to the heart and blood flow to the organs, and extremities. - Recommend side-lying positions |
| Discomforts in Pregnancy | Varicosities (varicose veins) - Light exercise, avoid long periods of sitting and standing. Compression stockings do not seem to help during pregnancy Hemorrhoids - Recommend measures to avoid constipation |
| Discomforts in Pregnancy | - Headaches - After 20 Weeks, should be evaluated for Preeclampsia Breast Tenderness - Recommend a supportive, well-fitted bra. |
| Discomforts in Pregnancy | Braxton Hicks Contractions - Painful contractions that do not change the cervical dilation - If rest or hydration slows or stops contractions, it is not true labor. |
| Discomforts in Pregnancy | Worsened Vision, Blurred Vision, Dry Eyes - Hormonal changes - Vision changes are generally minor and reverse in the first several months postpartum. |
| Discomforts in Pregnancy | - Patients should be taught to report loss of vision, blind spots, blurred vision, or double vision, as it may indicate abnormal complications (Ex, Preeclampsia) |
| Discomforts in Pregnancy | Increased Vaginal Discharge - Discourage strong soaps or douching as they can cause vaginal discomfort and even ectopic pregnancies in some cases. - Report discharge that has a foul odor, color change, or bleeding. |
| Discomforts in Pregnancy | Urinary Frequency and Incontinence - Reassure the patient that these changes usually resolve after pregnancy. - Kegel exercises are done to tighten the pelvic floor muscles. |
| Discomforts in Pregnancy | Food Cravings & Food Aversions - PICA (craving non food items like dirt/ice cubes, commonly associated with anemia and other nutritional deficits) Ptyalism (Hypersalivation) - Suck on hard candies or using mouthwash |
| Discomforts in Pregnancy | Heartburn (d/t hormonal factors, reduced peristalsis. & pressure from the abdominal cavity) - Avoid fatty food, & excess liquids with meals - Avoid lying down after eating - Avoid eating 3 hours before sleep |
| Discomforts in Pregnancy | Nausea and Vomiting in the First Trimester due to Increased hCG (human chorionic gonadotropin) |
| Discomforts in Pregnancy | Constipation (d/t reduced peristalsis and increased water absorption in the colon) - Increase fiber, fluids, and light exercise Lower Back Pain - Pelvic tilt or rocking exercises may help relieve pain. Acne & Dry Skin (d/t hormonal changes) |
| Prenatal Care | Low Risk Patients: - First Trimester - One Visit Monthly Until 28 Weeks - 28 - 36 Weeks - Visits Every 2 Weeks - 36 Weeks Until End of Pregnancy - Weekly Visit |
| Prenatal Appointments | - Physical assessment - History since the last appointment - Vital signs and weight assessment - Fetal heart rate assessment - Fundal height measurement after 16 weeks of gestation - Pertinent education |
| Prenatal Appointments | Screening & Assessment - Health Hx & Estimated Due Date (EDD) - Current Medications/Supplements - Psychological Response (to pregnancy) - Assess for Genetic Risks |
| Prenatal Appointments | Laboratory Tests - Blood Types - HIV/Gonorrhea/Chlamydia Patient Education - Health Promotion |
| Prenatal Appointments S/Sx to report to HCP | - Leakage of fluid from the vagina - Vaginal Bleeding - Reduced Fetal Activity - A headache that does not improve with Acetaminophen (Tylenol) - RUQ Pain - Vision Changes |
| Prenatal Appointments S/Sx to report to HCP | - Persistent contractions - New-onset lower back pain - Sensation of pelvic pressure - Menstrual-like cramps - Dysuria (painful urination) |
| OB Providers: Midwives (Nurse or Lay) | - RNs with advances training - Nurses are Allowed to Supervise Their Patients - May Attend Births in Hospitals, Birthing Centers, and/or at Home - Typically Better for Low-Risk Pregnancies |
| OB Providers: Physicians | - More Appropriate for High-Risk Pregnancies and Complications - May Perform C-Sections, Vaginal Births, and Complex Repairs - Low or High Risk Patients |
| OB Providers: Doulas | - Attend Births as Support People - Meet the Family’s Nonmedical Needs - Not Responsible for the Birth Itself |
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