OB Final Exam Study Guide.

1. What is antepartum? a. Pertaining to the time during pregnancy before the onset of labor 2. Probable, presumptive, positive signs of pregnancy. Presumptive indications: indications that are subjective changes that are experienced and reported by the women. Least reliable when confirming pregnancy; can be caused by conditions other than pregnancy a. Amenorrhea: absence of menstruation b. Nausea and vomiting:60-80% of women experience N/V. Beginning at 4-8 weeks and usually ending at 10-12 weeks c. Fatigue: fatigue and drowsiness during the first trimester; cause unknown (hormone changes possible) d. Urinary frequency: results from hormonal and fluid volume changes e. Breast and skin changes: breast changes begin by 6th week-breast tenderness, tingling, fullness, increased size and pigmentation of areolae. Increased pigmentation of skin resulting from estrogen and progesterone on melanocytes f. Vaginal and cervical color change: Chadwick sign is one of the earlies signs of pregnancyBluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion g. Fetal movement: not until second trimester. 16-20weeks. Probable indications: objective findings documented by examiner h. Abdominal enlargement i. Cervical softening: noted during pelvic exam j. Changes in uterine consistency k. Ballottement: tap on cervix during vaginal exam may cause the fetus to rise in the amniotic fluid and then rebound to its original position l. Braxton Hicks contraction m. Palpation of the fetal outline n. Pregnancy tests: detect hCG which is secreted by placenta and present in maternal blood and urine Positive indications o. Auscultation of fetal heart sounds: heart sounds can be heard with a fetoscope by 18 – 20 weeks. Doppler is used to detect heart motion and makes audible sound by 9 – 12 weeks p. Fetal movements felt by examiner: considered a positive sign; not to be deceived by peristalsis in large intestine q. Visualization of the fetus: ultrasonography-view the embryo or fetus and observe the fetal heartbeat 3. Normal pregnancy labs a. UNRS 402 OBFinal Exam Study Guide b. 4. Missed, threatened, incomplete, inevitable abortion. a. Abortion: loss of pregnancy before the fetus is viable, or capable of living outside the uterus b. Symptoms: i. Bleeding ii. Cramping iii. Loss of pregnancy symptoms (Matching question) c. POC-products of conception d. D&C-dilation and curettage (surgery that dilates the cervix and cleans out the uterus) Spontaneous Abortion (SAB): termination of pregnancy without action taken by the woman or another person e. Common cause is severe congenital abnormalities that are often incompatible with life i. Threatened abortion: the cervix is not dilated, and the placenta is still attached to the uterine wall, but some bleeding occurs. 1. The baby is still alive. The bleeding might resolve with bedrest, and she might be able to continue the pregnancy, but a miscarriage is a possibility. ii. Imminent/Inevitable abortion: the placenta has separated from the uterine wall, the cervix has dilated, and the amount of bleeding has increased. 1. There is so much bleeding that a miscarriage is inevitable, it can’t be stopped. The baby still has a heartbeat a. Vacuum curettage: removal of uterine contents with a vacuum curet- to clear uterus if natural process is ineffective or incomplete b. Dilation and curettage (D&C): stretching the cervical os to permit suctioning or scraping the uterine walls- if pregnancy is more advanced or if bleeding is excessive iii. Incomplete abortion: the embryo/fetus has passed out of the uterus; however, the placenta remains 1. Priority intervention-start an IV for fluid replacement and drug administration 2. D&C (may not be performed if the pregnancy has advanced beyond 14 weeksdanger of excessive bleeding) iv. Complete abortion: all products of conception are expelled from the uterus and uterine contractions and bleeding subside, and the cervix closes 1. No additional intervention required 2. Watch for excessive bleeding UNRS 402 OBFinal Exam Study Guide v. Missed abortion: the fetus dies during the first half of the pregnancy but is retained in the uterus 1. Ultrasound exam confirms fetal death 2. Pregnancy tests for hCG should show decline in placental hormone production 3. D&C is performed, D&E for second trimester vi. Recurrent spontaneous abortion: three or more spontaneous abortions (sometimes defined as two or more pregnancy losses) 1. Primary cause is believed to be genetic or chromosomal abnormalities and anomalies of the reproductive tract 5. TPAL a. Pregnancy history b. G – Gravida (total # of pregnancies) c. P – Para (total births) i. Twins count as 1 pregnancy and 1 birth d. TPAL i. T – Term (>37 weeks gestations at birth) ii. P – Preterm (20 – 37 weeks at birth) iii. A – Abortions (spontaneous or elective/induced <20 weeks) iv. L – Living children 6. Plasma volume in pregnancy a. Changes in Cardiovascular: b. Plasma volume increases from 6 to 8 weeks until 32 weeks of gestation i. 40% - 60% (1200 to 1600 mL) greater than nonpregnant women 1. Increase is higher in multifetal pregnancies c. Reason for increase unclear – may be related to vasodilation from nitric oxide, and estrogen, progesterone, and prostaglandin stimulation of RAAS which causes sodium and water retention d. Increased volume is needed to: i. Transport nutrients and oxygen to the placenta, where they become available for the growing fetus ii. Meet the demands of the expanded maternal tissue in the uterus and breasts iii. Provide a reserve to protect the pregnant woman from the adverse effects of blood loss that occurs during childbirth e. Red blood cell volume: i. Increases about 20% - 30% above prepregnancy values ii. Both RBC and plasma volume expand, increase in plasma volume is more pronounced and occurs earlier 1. Resulting dilution of RBC causes decline in maternal hemoglobin and hematocrit 2. Physiologic anemia of pregnancy or pseudoanemia of pregnancy a. Reflects dilution of RBCs in the expanded plasma volume rather than an actual decline 7. Fundal height during pregnancy.