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OB Test 2
Ch. 15-21
147
Nursing
Undergraduate 4
10/11/2010

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Cards

Term
First thing to do in an initial antepartal exam.
Definition
Have woman provide clean urine specimen.
Term
Abortion
Definition
Birth occurring <20 wks or 500 g.
Term
Gravida
Definition
Pregnancy of any duration including current.
Term
Para
Definition
Birth >20 wks regardless of alive or dead.
Term
Fetus born dead after 20 wks.
Definition
Still birth
Term
Nagele's Rule
Definition
- 3 months + 7 days LMP
Term
Common skin changes in pregnancy
Definition
Spider nevi, linea nigra, striae gravidarum, melasma.
Term
What can happen to the nose in pregnancy?
Definition
Edematous
Term
What can happen to the mouth in pregnancy?
Definition
Gingival hypertrophy
Term
What can happen to the thyroid during pregnancy? When?
Definition
Hyperplasia - 3rd month
Term
When is breast increase noted?
Definition
First 20 weeks.
Term
What sensation is noted in the first and third trimesters?
Definition
Tingling of the breasts
Term
When may colostrum be present?
Definition
After 12 weeks.
Term
Normal <3 changes in pregnancy
Definition
Palpitations, short systolic murmurs.
Term
Separation of abdominal muscles.
Definition
Diastasis of the rectus muscle.
Term
Tapping sharply on uterus - if baby floats up and comes back down.
Definition
Ballottement.
Term
Softening of cervix
Definition
Goodell's sign
Term
Softening of isthmus of uterus
Definition
Hegar's sign
Term
Bluish color of cervix
Definition
Chadwick's sign
Term
Danger signs of pregnancy
Definition
Gush of fluid
Vaginal bleeding
Abdominal or epigastric pain
Fever
Persisten vomiting
Oliguria
Dysuria
Absence of fetal movment
Muscle irritability or convulsions
Dizziness, blurred vision, spots in eyes
Edema
Term
How often do women need prenatal exams?
Definition
Every 4 wks until 28 wks.
Every 2 wks until 36 wks.
Every wk until delivery.
Term
When is GBBS testing done?
Definition
36 wks
Term
Fundus location at 10-12 wks
Definition
Slightly above symphysis pubis
Term
Fundus location 16 wks
Definition
Halfway between symphisis and umbilicus
Term
Fundus location at 20-22 wks
Definition
At umbilicus
Term
Fundus location 28 wks
Definition
3 finger breadths above umbilicus
Term
Fundus location at 36 wks
Definition
Just below ensiform cartilage
Term
When is gestational age most accurate with fundal height?
Definition
22-34 wks
Term
High risk factors for pregnancies
Definition
>4 pregnancies
Baby weighing >8.5 lbs
Height <5 ft
Low socioeconomic status
<16 yrs >35 yrs.
Term
What do gravida and para associate with: births or pregnancies?
Definition
Pregnancies
Term
When is the doppler able to amplify fetal heart sounds so that they can be heard?
Definition
8-12 wks
Term
Which factors decrease the reliability of fundal height for gestational age?
Definition
Uterine fibroids
Obesity
Hydramnios
Term
What complication is a pregnant woman <16 years old most likely to develop?
Definition
Preecclampsia
Term
When are tub baths contraindicated for pregnant women?
Definition
Vaginal Bleeding
Ruptured Membranes
Term
What super relaxing places should pregnant women not go?
Definition
Hot tub & sauna
Hyperthermia=teratogenic
Term
How late in pregnancy can women fly safely if they have no complications?
Definition
36 wks
Term
What DVT precautions should pregnant women especially take when flying?
Definition
Wear support hose & drink plenty of fluids
Term
What stretch stretches the inner thighs and glutes?
Definition
Taylor-sit
Term
What do pregnant women need to keep their heart rate below during exercise?
Definition
140 bpm
Term
What stretch is good for the lower back and spine?
Definition
Pelvic tilt (cat/cow)
Term
What age groups have the highest risk of preterm births and low birth weights?
Definition
Women <16 and >35
Term
12-14
Definition
Early adolescence
Term
Late adolescence
Definition
15-19
Term
Fetus' head too large for pelvis
Definition
Cephalopelvic disproportion
Term
Why is the US the leader in adolescent pregnancy?
Definition
Failure of contraceptive education and availability
Term
How long is the lag time between initiation of sexual activity and use of contraception?
Definition
6 months
Term
Are there more adolescent pregnancies in MO in ages 15-17 or 18-19?
Definition
18-19 (2/3 total)
Term
Describe the typical partner of the pregnant adolescent.
Definition
1-3 years their senior, usually in a relationship.
Term
Weight gain/rate for normal BMI
Definition
25-35 lbs
3.5-5.0 lbs 1st trimester + 1lb/wk after
Term
Mineral that promotes cellular metabolism & smooth muscle relaxation.
Definition
Mg2+
Term
Mineral promotes growth of fetus & sufficient lactation
Definition
Zinc
Term
System Omega 3 has most effect on
Definition
Nervous system
Term
Hormone that plays a role in immune function
Definition
Vitamin D
Term
Amt of sun exposure needed per week to get enough Vitamin D
Definition
5-30 minutes arms & legs exposed 2x/wk
Term
Months that it is impossible to get enough Vit D from the sun in Missouri
Definition
Nov-Feb
Term
What is the largest way in which high fructose corn syrup has contributed to lifestyle diseases?
Definition
Cheaper than sugar -> bigger portions
Term
How much should cals increase for 2nd/3rd trimester & lactation from normal diet?
Definition
300 --- 500
Term
Non-pregnant protein requirements are 14 grams. What are they in pregnant women?
Definition
60 g
Term
How much does BMR inc. in pregnancy?
Definition
20%
Term
Most vegans need additional supplements of what?
Definition
B12, Iron, D, Calcium
Term
How long after menarche do women reach their full height?
Definition
5-6 years
Term
Can you have sex after an abortion?
Definition
No - maintain bed rest and hospitalization if persistent bleeding.
Term
What conditions is Methotrexate used for?
Definition
Abortion, Ectopic Pregnancy & Gestational trophoblastic disease
Term
Cervix is not dilated & placenta still attached to uterine wall, but some bleeding occurs.
Definition
Threatened abortion
Term
Placenta has separated from uterine wall, cervix has dilated and the amt of bleeding has increased
Definition
Imminent Abortion
Term
Embryo or fetus has passed out of the uterus, but the placenta remains
Definition
Incomplete abortion
Term
Most commons site for ectopic pregnancy
Definition
Ampulla of fallopian tube
Term
If HcG levels are stable, what may be happening?
Definition
Ectopic pregnancy - normally levels double frequently.
Term
What is the classic symptom of ectopic pregnancy?
Definition
Sharp, unilateral pain & lower abdominal pain
Term
If women do not desire to become pregnant in the future, what are options for ectopic pregnancies?
Definition
Salpingostomy/Salpingectomy
Term
Med that stops cell division and causes tissue to die
Definition
Methotrexate
Term
Pathologic proliferation of trophoblastic cells including molar pregnancy
Definition
Gestational Trophoblastic Disease
Term
What are the chromosomes in gestational trophoblastic disease usually like?
Definition
Monosomic or Trisomic
Term
Signs of gestational trophoblastic disease
Definition
Uterine enlargement > gestational age
Bleeding
Hyperemesis gravidarum and early pre-ecclampsia (12 wks)
Term
How long must women who have had gestational trophoblastic disease wait to conceive?
Definition
1 year - with monitoring of HcG levels.
Term
A woman who has had repeated second trimester abortions may have what?
Definition
Incompetent cervix
Term
Procedure where cervix is tightened with purse-string suture until at term.
Definition
Cerclage
Term
Main causes of bleeding during second half of pregnancy.
Definition
Abruptio placentae
Placenta previa
Term
What normal nursing action must you not take in patients with placenta previa?
Definition
Cervical checks
Term
What is diagnostic for hyperemesis gravidarum?
Definition
Intractable vomiting
5% wt. loss
Term
What meds can be used to control vomiting in hyperemesis gravidarum?
Definition
Zofran
Vit B6 + Benadryl
Term
What % of preterm births does PPROM occur in?
Definition
1/3
Term
Methods to prevent infection in PPROM
Definition
Sterile speculum to detect amniotic fluid
Limit digital exams
Term
How many hrs after PROM does risk for infection ^?
Definition
18 hrs - 80% women are in labor within 12
Term
Uterine contraction frequency Dx for labor
Definition
4 in 20 min or 8 in 1 hr
Term
How much does the cervix have to be dilated and effaced for it to be considered labor?
Definition
>1cm w/documented change, 80% effaced
Term
If cervix >4cm long, what does this indicate?
Definition
Risk for preterm labor is low
Term
If cervico-vaginal fibronectin is detected, what does this mean?
Definition
Likely to go into labor soon
Term
Drugs to pause labor
Definition
Terbutaline, Ritodrine (B agonists), MgS04, Indomethacin, Nifedipine (Ca channel blocker)
Term
When does preeclampsia-eclampsia begin?
Definition
28 wks
Term
Patho preeclampsia
Definition
Vasoconstriction of the spiral arteries
Term
Maternal complications preeclampsia-eclampsia
Definition
Neuromuscular irritability
Headache & hyperreflexia
Seizures, RF, abruptio placentae
DIC, ruptured liver & pulmonary embolism
HELLP syndrome (Hemolysis, elevated liver enzymes, low platelet count)
Term
Fetal-Neonatal risks eclampsia
Definition
Small gestational age, Preterm, Mg toxicity
Term
140/90
Definition
Mild preeclampsia
Term
160/110
Definition
Sever preeclampsia
Term
Grand mal convulsion that can occur antepartum through postpartum
Definition
Eclampsia
Term
Proteinuria 5g in 24 hr urine
Dipstick urine protein 3+ to 4+
Visual/cerebral disturbances
Definition
Severe preeclampsia
Term
1+ proteinuria
Elevated liver enzymes
Edema
Definition
Mild preeclampsia
Term
Loss of DTRs & Resp depression in preeclampsia
Definition
Mg toxicity
Term
Marked fetal edema (hydrops fetalis)
CHF, Marked jaundice
Definition
Erythroblastosis fetalis (due to Rh & hemolytic syndrome)
Term
Indirect coombs test is done on ______ at ______.
Definition
Mother, initially, 28 wks & postpartum
Term
Direct coombs test is done on _____ at _______.
Definition
Baby at birth
Term
What does ABO incompatibility cause and how is it treated?
Definition
Hyperbilirubinemia (due to hemolysis) -- phototherapy
Term
This causes birth defects and is transmitted by eating raw/undercooked meat and contact with cat feces.
Definition
Toxoplasmosis
Term
Toxoplasmosis after 1st trimester can be treated with ________.
Definition
Spiramycin
Term
Virus for which we have a herd immunity but can cause severe birth defects if acquired during pregnancy.
Definition
Rubella
Term
Herpes virus transmitted trans-placentally & with direct cervical contact. Leading cause of deafness.
Definition
Cytomegalovirus
Term
Neonatal herpes transmission is greatest when?
Definition
If acquired near time of birth or if active lesion
Term
Tx HSV-1 or 2
Definition
Acyclovir
Term
If mother has active herpes lesion what is the best course of action for birth?
Definition
C-section within 4 hrs SROM.
Term
What % women have GBS?
Definition
1/3
Term
What kind of bacteria is GBS?
Definition
Aerobic
Term
This bacteria is potentially transmissible to infants via breastfeeding.
Definition
MRSA
Term
Why is erythromycin put in eyes/conjunctiva of newborns?
Definition
Prevent conjunctiva from gonorrhea/chlamydia infection.
Term
Does infection correlate with spontaneous abortions and preterm birth?
Definition
Yes
Term
If a woman has low CD4 counts (HIV) what is likely to happen during pregnancy?
Definition
May develop AIDS and opportunistic infection
Term
What is the current fetal transmission rate w/tx for HIV?
Definition
1-2%
Term
What is the therapy to prevent transmission of HIV from mom to baby?
Definition
C/S at 38 wks, Oral ZDV daily during pregnancy, IV during labor until birth, Oral ZDV for infant for 6 wks.
Term
Leading cause of preventable mental retardation in US.
Definition
Alcohol during pregnancy
Term
In diabetes, _______ crosses the placenta but ______ doesn't.
Definition
Glucose, insulin
Term
Insulin needs are ____ in the first trimester and postpartum.
Definition
Decreased
Term
When should diabetics become pregnant?
Definition
When they have excellent glycemic control.
Term
1 hr (50g) & 3hr (100g) glucose challenge test normal result
Definition
<140
Term
Folic acid deficiency anemia
Definition
Megaloblastic
Term
Hg level that affects fetus
Definition
<6
Term
Major risk for sickle cell pregnant women.
Definition
Increased susceptibility to infection
Term
Mild anemia condition r/t hgb chain
Definition
Thalassemia
Term
US needs full bladder and relatively thin woman
Definition
Abdominal US
Term
US benefits
Definition
Confirm multiple pregnancy, placental location, assess amniotic fluid volume, confirm viability

Guide for amnio & chorio
Term
_____ is visible on US at 8 wks
Definition
Gestational sac
Term
________ is measured between 7-12 wks
Definition
Crown rump length
Term
After 12 weeks ______ is measured on US
Definition
Biparietal diameter and femur length
Term
When is chorionic villi sampling done?
Definition
10-12 wks.
Term
When is amnio done?
Definition
After 14 wks
Term
When can placental previa be diagnosed?
Definition
>27 wks
Term
When can placenta be clearly seen on US?
Definition
14-16 wks
Term
What does the quad screen test for?
Definition
Downs, Trisomy 18, Neural tube defects
Term
The quad screen is _______ but not _________.
Definition
Sensitive, specific
Term
At 10-12 wks, nuchal translucency, free b subunit HcG and Papp-A can be tested. If these results are normal, what does this indicate?
Definition
Low chance of loss <20 wks.
Low risk of downs and trisomy 18
Term
Negative fetal fibronectin indicates what?
Definition
Labor is unlikely to occur in next two weeks.
Term
How often should a woman perform Fetal movement counts after 28 wks?
Definition
1x/day
Term
How many fetal movements in 1 hr are considered reassuring?
Definition
4
Term
NST: Baby is reactive if what?
Definition
Two accelerations at 15 bpm above baseline within 20 minutes when mom feels baby move.
Term
Negative contraction stress test is what?
Definition
No late decelerations w/min 3 UCs in 10 min period.
Term
When are velocity waveforms (doppler blood flow studies) typically used?
Definition
Twin pregnancies where worried one may be getting more blood than the other.
Term
This type of IUGR is more serious.
Definition
Symmetric IUGR
Term
L/S ratio at 30-32 wks is _____ at 35 wks is _____.
Definition
1:1; 2:1
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