Exam 1 Study Guide

1. USA Healthcare
Mediaid (Medical): Low income insurance, *Medicaid Eligibility requirements depend upon*:
Income Household size In some states, stage of pregnancy. For maternity care funding
Medicare: for 65 and over gov insurance.
PPO (Preferred Provider Org).: Can go to mostly any physician/practice.
HMO (Health Maintenance Org.): Only selected physicians/practices are covered.
Example Q2 ppt ch 14 answer: Health outcomes are NOT associated with higher cost. People
who have universal healthcare spend less than compared to private
Example Q3 ppt ch 14 answer: False. A health history includes physical ailments, obstetric
history, sexual history, family history, lifestyle assessment, questions about eating and sleeping,
demographic information, allergies, and exposure to environmental habits. (NOT to understand
ailments)
2. Gravida Para Abortion Living Children
Gravidity: # of pregnancies Parity: # of births carried min. 20 weeks or more Abortion: # of
induced abortions or miscarriages under 20 weeks Living children: # of children alive
Term: pregnancy carried to 37 weeks Preterm: pregnancy carried from 20-36 weeks
3. Fertilization time process
Ova are viable for fertilization for 6-24 hours, sperm can fertilize egg up to 5 days. Most often
occurs in the fallopian tube. Cortical reaction: Other sperm are blocked from fertilizing egg
that's already been fertilized. 23 chromosomes of sperm + 23 remaining chromosomes of the
ovum = diploid zygote with 46 chromosomes.
4. Presumptive, Probable and Positive Signs of Pregnancy
Presumptive: Amenorrhea (absence of period), breast tenderness, nausea
Probable: Braxton hicks contractions, + preg. test, softening of cervix (goodell's sign), bluish
discoloration of genitals (chadwick's sign)
Positive: Fetal heartbeat, fetal US, HCG production, doubling every 48-72 hrs, preg test detects
HCG. False negatives can occur if so repeat 3-7 days, caused by user error or fertility treatments
or recent pregnancy loss
5. Embryo vs Fetus aging
Embryonic stage: 10 days to 8 weeks
End of week 2: implantation happens.
Week 3: Neural tube fuses in center and tubular heart begins to beat.
Week 4 Resp and GI tract begin to form and the neural tube finishes fusing.
Week 5: limb buds.
Week 6: Heart final form
Week 8: First brain waves detectable
Fetal Stage: Week 9- 38+ Under 37 weeks = Preterm
Week 9-12: fetal movements begin, kidneys being to work, genitalia fully differentiated
Week 13-16: oogenesis (egg prod.) established in females, blood vessels visible under skin,
ridges that form hand, foot, finger, toe present.
Week 20: Fetal swallowing present, insulin prod. Begins, lanugo, vernix c. all over body.
Week 24: Lungs form surfactant
Week 28: Testes descend, fetus moves to head down position, blood prod. in bone marrow
Week 29-34: SubQ fat deposits and HR variability more pronounced due to CNS maturity
Week 33-38: Visual acuity is 20/600, vernix only in skin creases, lanugo upper back and
shoulders. Lungs and CNS mature while fetus grows and gains weight
6. Naegele's Rule
LMP - 3 months + 1 year + 7 days = Birth due date
7. Umbilical Cord
Arises from fetal side of placenta, conduit for blood traveling to and from baby, at birth 55cm
long, 2cm in diameter. 1 Large vein carries oxygenated blood to fetus and 2 small arteries
carry deoxygenated blood to placenta. Covered in wharton jelly to support and protect vessels
often twisted due to fetal movement.
8. Placenta's job
Acts as circulatory system between mom and baby, forms at site of blastocyst implantation,
attaches with chorionic villi. Expands until 20 weeks, 2.5-3cm thick 38-51 in diameter. Fetal side
is shiny and smooth called shiny schultz. Maternal side has red meaty appearance called dirty
duncan. Functions: Circulation, protection and hormone production.
9. Striae Gravidarum, Linea Negra, Chloasma, Palmar Erythema
Striae Gravidarum: Stretch marks
Linea Negra: Black line on midline of stomach. From pubic symphysis to fundus. Typically pts
with darker skin, fades gradually after pregnancy
Chloasma: Mask of pregnancy, darkens w. Sun exposure, disappears after pregnancy.
Palmar Erythema: caused by increased blood flow and is harmless and painless. Blood vessel
dilates, due to increased estrogen
10. Fetal Endocrine System Support by Mom
Mom supplies thyroid hormones until week 12, then baby makes it on its own. Thyroid critical to
neurological development. Thyroid increases during pregnancy, insulin needs increase during
beginning second half of pregnancy. If pancreas cannot keep up w, insulin demand = Gestational
DM. Cortisol increases 2nd trimester may promote lung and neurological development.
Oxytocin is made by posterior pituitary, has role in producing contractions, postpartum uterine
contractions and milk ejection.
11. Oxygen Consumption in pregnancy
O2 usage increases 15-20%. Tidal volume air exchange increases 40-50%. Mild hyperventilation
and sense of dyspnea = physiological respiratory alkalosis (blowing off too much CO2 than
normal for fetal CO2 circulation to diffuse into maternal blood stream while O2 diffuses to
fetus). Diaphragm elevates 5cm = ribs expand and subcostal angle increases. Increased estrogen
= congestion of mucous membranes = swelling of pharynx, larynx, trachea. Engorged capillaries
= frequent nose bleeds
12. Blood Volume and Cardiac Output
Cardiac output increases 50%. Hormones reduce peripheral vascular resistance to compensate for
increased blood volume. Total blood volume increases 40-50%. WBC increases 30%, may not
indicate infection. Total increase = physiological anemia of pregnancy. Increase in fibrinogen to
increase clotting to prevent postpartum bleeding. BUT increase of PE or stroke
Example Q2 ch 15 ppt answer: A nurse expects a patient’s hemoglobin and hematocrit to be
lower at the end of pregnancy than they were at the patient’s initial prenatal visit. TRUE. The
volume of plasma increases more than the increase in red blood cells during pregnancy. The net
result is an expected decrease in hemoglobin and hematocrit.
13. Braxton Hicks Contractions
Practice contractions or false labor, are sporadic uterine contractions. Painful contractions that do
not change the cervix
14. Goodell's Sign, Chadwick's Sign, Hegar's Sign
Goodell sign: Softening of cervix
Chadwick's sign: Bluish discoloration of genitals
Hegar’s sign: Softening of uterus at junction of cervix (they now feel separate)
15. Diastasis Recti and Lordosis
Diastasis Recti: Abdominal walls separate at the midline
Lordosis: exaggerated curve to the lumbar spine, = shift to the patient’s center of gravity =
increases the risk of falls
16. Dyspnea and Epistaxis
Dyspnea: Difficulty breathing. Improved posture may increase lung expansion. Light exercise
and stretching may help breathlessness.
Epistaxis: Nosebleed. Saline nasal sprays or humidifiers may help with chronic nasal congestion
or nosebleeds.
17. Carpal Tunnel
Carpal tunnel syndrome may temporarily occur during pregnancy due to edema around nerves of
the wrist.
18. Hyperemesis Gravidarum and N/V
Hyperemesis Gravidarum: severe nausea and vomiting. Asses for malnutrition, dehydration
and labs. Can cause weight loss, dehydration, ketonuria, and electrolyte imbalances. To alleviate:
should recommend small frequent meals, or use anti emetics like zofran but may be teratogenic.
Administration of parenteral electrolytes, suppositories, vitamin b6 or ginger candies.
Risk factors: Multiple pregnancy, anxiety, depression, history of HG, hyperthyroidism, GI
disease, female fetus, gestational trophoblastic disease
19. Pica
Craving nonfood items and may be associated with nutritional deficits
20. Ptyalism
Increase saliva production. Can be managed by using sucking candies or using mouthwash
21. GBS
Group B streptococcus: Bacteria normally found in GI tract, vagina and urethra. Normal flora
of vagina. ¼ women have GBS in their bodies. 35-37 weeks they do GBS swabs. Can cause
infection in babies when delivering. Early onset (in the first few weeks) BGS or late onset (until
3 months of age). Sx: respiratory issues, sepsis, and meningitis. If positive: IV abx, penicillin (if
allergic: use cephalosporin) based antibiotic when laboring. Every 4-6 hours. 1/4000 will get
infection after abx. wo. abx ½ babies will get infection. Can get treated as positive if: Water
breaks before 37 weeks, GBS positive urine sample, waters broke for over 18 hrs, prev baby w.
GBS.
22. Nutritional Supplementation
Supplements to take while pregnant: Iron, vit D, folate.
Vegan diet = low morning sickness. Lower rates of preeclampsia. Breast milk low levels of
contaminants. Lowers T1DM risk.
Dairy = increased risk of childhood asthma, messes w. Hormones. Contributes to cancers,
inhibits iron absorption. Can cause colic in infants.
Fish: Contaminate body w mercury and other toxins. Can contribute to diabetes and childhood
obesity.
Meat: Contributes to obesity, higher cortisol levels, exposes you to pollutants, contributes
morning sickness and exposes you to pathogens.
23. Toxoplasmosis
Parasitic infection: do not clean cat box, can be found in cat feces or in dirt. Recommend not to
garden. Also found in some foods, cook thoroughly.
24. Twin Types
Dizygotic/Fraternal Twins: When 2 eggs are fertilized. Risks for twins are: fertilization
treatments ART (artificial reproductive technology ex. IVF) , history of twins in family, or
ethnicity.
Monozygotic/Identical Twins: Occurs after fertilization of 1 ovum (it splits), shares placenta
amnion, chromium Considered a spontaneous event Risk: Later cleaving can cause twins to
share structures and even become conjoined.
Twin to twin transfusion: one twin takes all the nutrients from other twin, high risk of fetal
demise
Multifetal pregnancy increases the risk of mom and baby. Risks: GDM, PRE-E, PE, fetal growth
restriction, fetal anomalies, pregnancy loss, stillbirth and placenta previa (placenta attaches over
cervix), more nausea, more headaches, more edema, increased prematurity 50% of twins are
born early, umbilical cord entanglement risk
25. SAB Types
Spontaneous abortion types:
Complete: Findings are passing clots and tissues, heavy cramping and bleeding. Cervix is closed
and residual blood present in vagina.
Missed: Patient reports amenorrhea, cervix is closed, pregnancy not developed but not passed
out of cervix. Considerations: wait until 6 weeks of preg. To allow for passage, can use
misoprostol which dilates the cervix for passage, 2nd trimester = evacuation and dilation.
Inevitable: Heavy cramping and bleeding, some passage of clots and tissue, cramping and
bleeding, cervix is open. Considerations: Dilation and curettage or evacuation.
Threatened: cervix closed but bleeding, patient has possible cramping. Considerations: lab
monitoring of HCG and US.
Recurrent: Defined as two losses of clinically documented or 3 preg in a row.
26. Ectopic and Molar Pregnancy
Ectopic pregnancy: Pregnancy occurring outside uterus, usually in fallopian tube. It’s life
threatening and pregnancy must not continue. If tubes rupture it causes internal bleeding and
death. Ampulla: Widest part of fallopian tube, most ectopic pregnancies happen there. Sx:
severe pelvic pain referred to one shoulder and bleeding. Dx: HCG labs and US. Risk factors: Hx
of pelvic infection, Hx of infertility or fertility treatments, smoking, douching. Tx: can be
medically or surgically depending on time of discovery. Methotrexate helps reabsorb pregnancy,
kills embryo.
Gestational Trophoblastic Pregnancy (GTD) AKA Molar pregnancy: Nonviable mass of
trophoblastic tissue, contains no genetic material. Can happen when 2 sperm fertilizes 1 egg, can
have some fetal parts but still not viable. Grows at abnormal fast rate, high levels of HCG, can
spread beyond uterus. It becomes a cancerous mass, can metastasize to vagina, lungs and
nervous system.. Dx: US Tx: Hysterectomy, dilation and curettage. Prophylactic chemo serial
serum HCG levels for 6m-1y and avoiding pregnancy for 1 year.
27. 140/90 and 100.4 F(38C) Vital Signs
Gestational HTN: BP is at 140/90 or higher. 50% of GHTN patients develop preeclampsia. If
protein is in urine or high creatinine = Preeclampsia. Complications: Small for gestational age
infants, preterm, and placental abruption.
Preeclampsia: happens in 2-5% of pregnancies. Causes Oligohydramnios, Placental abruption,
Intrauterine growth restriction. Material risks: Renal damage leading to renal failure, PE, Liver
damage and impaired liver function, Cerebral edema and hemorrhage, Thrombocytopenia
platelet count <100,000. Tx: magnesium sulfate to prevent seizures by reducing CNS irritability,
antihypertensives. To reduce risk: aspirin and calcium
Eclampsia: Preeclampsia with tonic clonic seizures w. No known cause.
Infection: is temp is above 100.4F
28. 110-160 BPM Fetal Heart Rate
Normal heart rate for fetus 110-160 until 1 years old. Always count on increments of 5
29. Oligohydramnios
Decreased amniotic fluid may be caused by fetal abnormalities and premature membrane
ruptures. Can cause cord compression.. Poor prognosis. Dx: US or if AFI (amniotic fluid index)
is under 5 cm and 2 cm. Tx: Amnioinfusion of ringers lactate into amniotic sac.
30. IUGR
Intrauterine growth restriction: Condition that indicates there is a complication of pregnancy. 10
% of pregnancies have IUGR. Cause can be material, fetal or placental. Infants with IUGR are at
risk for hypoglycemia, thermoregulation issues, respiratory distress after birth, SGA
31. Cervical Insufficiency
Painless premature dilation of cervix in 2nd trimester, high risk of miscarriage or premature
birth. Dx: US of cervix and measuring length, or hx 2nd trimester losses. Tx: Maternal
progesterone supplementation or cervical cerclage (sewing cervix close)
32. CPR In Pregnancy
When a pregnant patient needs CPR it's the same as a normal person, sometimes they will deliver
the baby so the moms body can focus on staying alive rather than maintaining the embryo/fetus.
33. TORCH
Toxoplasmosis: Parasitic infection: do not clean cat box, can be found in cat feces or in dirt.
Recommend not to garden. Also found in some foods, cook thoroughly. Complications: Preterm
birth, spontaneous abortion Fetal: Prematurity, low birth weight, severe eye, brain injuries. Tx:
Sulfonamides or a combination of pyrimethamine and sulfadiazine (potentially harmful to the
fetus, but parasitic treatment is essential
Other: Gonorrhea, chlamydia: Asymptomatic, can cause ophthalmia neonatorum. Syphilis:
Complications: Brain and eye conditions Increase the risk for developing HIV Long term
systemic conditions has 3 stages. Primary: chancre sore/ lymph edema. Secondary: Skin rashes,
latent phase: no findings present. Tertiary: damage to internal organs, blindness, difficulty w
muscle movement. Tx: Penicillin G. Trichomoniasis: Causes yellow/green discharge intense
itching and painful urination, needs ABX. HIV
Rubella: Complications: Rubella can cause fetal consequences (congenital anomalies, death).
increase the risk for miscarriage. Pt should get vaccinated MMR, but only post partum live
MMR is contraindicated. Before pregnancy should avoid pregnancy for at least 1 month after
receiving the vaccine.
Cytomegalovirus: In herpes virus family, it’s teratogenic. Latent virus can be reactivated and
cause disease to the fetus in utero or during passage through the birth canal.Complications:
During 1st trimester, Fetal: neurodevelopmental deficits, sensorineural hearing loss, seizures,
cerebral palsy. Actions: Encourage hand washing to prevent exposure.
Herpes: Complications: cause miscarriage, preterm labor, and intrauterine growth restriction.
Can be transmitted during children if active lesions, can lead to bad complications. Mom is given
antiviral, mostly they do C section. Tx: acyclovir/valacyclovir
Other info:
MSAFP- tests for genetic abnormalities
Colostrum- yellowish form of early milk is produced and may leak from nipple
Reproductive hormones: Estrogen, Progesterone, LH, FSH. Ovaries, anterior pituitary, and the
hypothalamus regulate the female reproductive cycle. When estrogen and progesterone levels are
low, the hypothalamus produces gonadotropin-releasing hormone (GnRH). Resulting in: anterior
pituitary releasing LH and FSH. FSH is responsible for maturation of ovarian follicles that will
release eggs for fertilization. LH levels peak approximately 12 to 24 hours prior to ovulation.
After ovulation (follicle rupture), the ovarian follicle is called a corpus luteum => produces large
amounts of progesterone and a smaller amount of estrogen, which maintain the uterine lining for
Implantation.
GDM: Gestational diabetes mellitus. Testing 23-28 weeks: Oral gestational glucose test 1 hr if
above 140 move to 3 hrs. Risks: include stillbirth, fetal macrosomia, and postpartum
hemorrhage.