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OB Exam 1
OB chapter 12
| Question | Answer |
|---|---|
| preconception care and diagnostic testing | Amniocentesis Biophysical profile Chorionic villus sampling (CVS) Natural childbirth Perinatal education Preconception care |
| amniocentesis | removal of amniotic fluid, sent to lab and lab can say if there are genetic issues or not |
| when does amniotic fluid develop | 8-10 weeks gestation |
| what do you need for amniocentesis | Ultrasound because you don't want the needle to puncture the placenta or uterine canal |
| amniocentesis causes risk for what | mother to go into labor |
| biophysical profile (BBP) | determines health of fetus looks at HR, RR, movement, muscle tone, amniotic fluid |
| is BBP invasive | no! |
| BBP scores | 8–10: Normal/reassuring fetal status 6: Equivocal—may require repeat testing or further evaluation 4 or less: Abnormal |
| how does BBP scoring work | 2 points per each category |
| chorionic villus sampling (CVS) | as placenta develops and fertilized egg develops, roots look like fingers within the placenta which are called villi and are then snipped and sent to lab |
| is CVS invasive | yes! |
| CVS causes risk for what | mother to go into labor |
| natural childbirth | no analgesia or anastetic, no epidural! |
| perinatal education | providing info about preparing for pregnancy and during, suggest classes |
| preconception care | prior to pregnancy, up to 1 year before |
| goals of preconception | Promote the health and well-being of a birthing person and their partner before pregnancy Identify and modify biomedical, behavioral, and social risks to a person's health or pregnancy outcome through prevention and management intervention |
| ask about these things during ante-natal, even within the family | Isotretinoins Alcohol misuse Antiepileptic drugs Diabetes (preconception) Folic acid deficiency HIV/AIDS |
| Isotretinoins are associated with | chromosomal abnormalities |
| Alcohol misuse can cause | fetal alc syndrome/disease |
| folic acid deficiency can cause | neural tube defects |
| if a mother has these things, the require monitoring and frequent probing | Hypothyroidism Rubella seronegativity Obesity STI Smoking Hypertension |
| Hypothyroidism | impacts thyroid function of fetus |
| Rubella seronegativity | can cause issues with eyes, hearing, cognitive function |
| obesity | baby can have glucose issues |
| STI | Syphilis at certain stages can cause rash on palms |
| smoking | can cause smaller fetus than non smokers |
| hypertension | decreased blood flow/oxygen to fetus, so fetus would be smaller |
| questions to ask at initial prenatal visit | Immunization status Underlying medical conditions Reproductive health care practices Sexuality and sexual practices Nutrition Lifestyle practices Psychosocial issues Medication and drug use Support system |
| two driving factors for maternal fatality | psychiatric problems and drug problems |
| at the first prenatal visit its important to | Establishment of trusting relationship Focus on education for overall wellness Detection and prevention of potential problems Comprehensive health history, physical examination, and laboratory tests |
| comprehensive health history | Reason for seeking care Past medical, surgical, and personal history Patient's reproductive history: menstrual, obstetric, and gynecologic history |
| Reason for seeking care could be | Suspicion of pregnancy Date of last menstrual period Signs and symptoms of pregnancy Urine or blood test for hCG |
| Suspicion of pregnancy aka | presumptive |
| Date of last menstrual period | even with conception, mother may be spotting |
| Past medical, surgical, and personal history | HTN, sickle cell, STDs |
| menstrual history | Menstrual cycle Age at menarche Days in cycle Flow characteristics Discomforts Use of contraception |
| if there is use of contraception | pt doesn't have true cycle hormones |
| date of last menstrual period aka | LMP |
| estimated or expected DOB | EDB |
| nagele's rule | way we can calculate due date, can be +/- 2 wks |
| nagele's rule equation | first day of LMP + 1 year − 3 months + 7 days |
| best method of dating pregnancy | ultrasound |
| gravida | pregnant person |
| Gravida I (primigravida) | first pregnancy |
| Gravida II (secundigravida) | second pregnancy |
| gravida does not mean | they birthed! |
| para | a person who has produced one or more viable offspring carrying a pregnancy 20 weeks or more "how long fetus was carried before delivered" |
| primipara | one birth after a pregnancy of at least 20 weeks (“primip”) |
| multipara | two or more pregnancies resulting in viable offspring (“multip”) |
| nullipara | no viable offspring; para 0 |
| count days and weeks to determine | maturity and viability of fetus |
| G | gravida, the current pregnancy |
| T | term births, the number of pregnancies ending >37 weeks gestation, at term |
| P | preterm births, the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks |
| A | abortions, the number of pregnancies ending before 20 weeks or viability (delivery prior to 20 wks) |
| L | living children, number or children currently living |
| physical examination | Vital signs Head-to-toe assessment |
| Head-to-toe assessment | Head and neck - look for grimacing Chest Abdomen, including fundal height if appropriate Extremities |
| when doing physical exam, ask | if it is okay to touch them regardless of monitors |
| when inserting your fingers to examine, | go into vagina, NOT uterus |
| measuring the fundal height if appropriate | not the most accurate, but do anyways get the most accurate measurement 32-34 wks |
| pelvic examination | Examination of external and internal genitalia Bimanual examination Pelvic shape Pelvic measurements |
| Pelvic shape | gynecoid, android, anthropoid, platypelloid |
| Pelvic measurements | diagonal conjugate, true (obstetric) conjugate, and ischial tuberosity |
| Bimanual examination | speculum to see cervix (lowest part of uterus) |
| platypelloid is not | as acceptable |
| lab tests | Urinalysis Complete blood count Blood typing Rh factor Rubella titer Hepatitis B surface antigen HIV, VDRL, and RPR testing Cervical smears Ultrasound |
| HIV, VDRL, and RPR testing relates to | Syphilis |
| cervical smears | capture fluid at external os |
| follow up visits schedule up to 28 weeks | every 4 weeks |
| follow up visits schedule 29 to 36 weeks | every 2 weeks |
| follow up visits schedule 37 weeks to birth | every week |
| in US, max term for pregnancy | 41 weeks, never 42 |
| assessments done during follow up visits | Weight and BP compared to baseline values Urine testing Fundal height Quickening/fetal movement Fetal heart rate |
| Urine testing | for protein, glucose, ketones, and nitrites |
| Quickening/fetal movement | first time mom feels fetus in uterine, described as flutter, burping or kick |
| teach danger signs during follow up appts | headaches, nausea, abdominal pain, spots, bleeding, fluid |
| assessment of fetal well being | Ultrasonography Doppler flow studies Alpha-fetoprotein analysis Marker screening tests Nuchal translucency screening Amniocentesis |
| Ultrasonography | takes picture of fetus |
| Doppler flow studies | shows flow of blood into vessels |
| Alpha-fetoprotein analysis | produced by liver, in amniotic fluid too high or too low suggests a chromosomal abnormalities |
| marker screening tests | non invasive screening |
| Nuchal translucency screening | fluid behind infants neck |
| any invasive tests | increase risk of putting into labor |
| assessment of fetal well being | CVS non stress test, contraction stress test BBP |
| CVS | done on the ultrasound to get snip of the villi |
| non stress test | non invasive, see when HR increases when baby moves and redo it if no increase |
| contraction stress test | done in facility because give oxytocin/Pitocin to increase contractions to observe baby for 30 mins |
| first trimester discomforts are driven by | progesterone and estrogen |
| first trimester discomforts | Urinary frequency or incontinence Fatigue Nausea and vomiting Breast tenderness Constipation Nasal stuffiness, bleeding gums, epistaxis Cravings Leukorrhea |
| second trimester discomforts | Backache Varicosities of the vulva and legs Hemorrhoids Flatulence with bloating |
| why is there back aches during 2nd trimester | changing center of gravity |
| Hemorrhoids because | constipation |
| Flatulence with bloating because | GI slows down |
| third trimester discomforts | Return of first trimester discomforts Shortness of breath and dyspnea Heartburn and indigestion Dependent edema Braxton Hicks contractions |
| Nursing Management to Promote Self-Care | Personal hygiene Avoidance of saunas and hot tubs Perineal care Dental care Breast care Clothing Exercise Sleep and rest Sexual activity and sexuality Employment Travel Immunizations and medications |
| Avoidance of saunas and hot tubs because | they impact BP |
| Perineal care | vaginal area because mom can't see below abdomen |
| clothing | no heels or tight clothes around abdomen |
| exercise | gentle, jog, walk in specific way, LOVE swimming |
| sexual activity and sexuality | until delivery, unless bleeding then NO |
| travel | after 34 weeks then NO |
| Preparation for Labor, Birth, and Parenthood | Perinatal education Childbirth education |
| Childbirth education | Lamaze (psychoprophylactic) method Bradley (partner-coached childbirth) method Dick-Read (natural childbirth) method |
| Lamaze (psychoprophylactic) method | focus on breathing and relaxation techniques |
| Bradley (partner-coached childbirth) method | focus on exercises and slow, controlled abdominal breathing |
| Dick-Read (natural childbirth) method | focus on fear reduction via knowledge and abdominal breathing techniques |
| options for birth setting | Hospitals: delivery room, birthing suite Birth centers Home birth |
| options for care providers | Obstetrician Midwife Doula for support/advocate |
| feeding choices | breastfeeding or bottle feeding, each have advantages and disadvantages |
Created by:
leh195