TCP - EXAM 1 - TCP STUDY GUIDE
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ANTEPARTUM CARE
Hormone Secreted by Functions Other Notes
hCG Trophoblast Stimulates corpus luteum to stimulate estrogen + progesterone until Low → ectopic pregnancy, spontaneous abortion
placenta is developed High → multiple gestation, choriocarcinoma
Progesterone Corpus Luteum Relaxes smooth muscle, inhibits uterine contraction (prevent
Placenta at 6-7 wks spontaneous abortion)
Has immune role (embryo is foreign)
Estrogen ---- Ovulation Makes ovulation possible
Organ maturation
Prepares mom for lactation period
Relaxin In the ovaries Promotes implantation plays a role early and later in pregnancy
hPL Placenta Antagonizes insulin → inc glucose for fetus → gestational DM
Glucocorticoids Cortisol derived from cholesterol Lung maturation (synthesis of surfactant) In utero lungs are collapsed, once delivered they need to open
PRL Anterior pituitary Produces milk
Oxytocin Posterior pituitary Uterine contraction
Milk ejection
Condition Overview Cause S/S Tx
Ectopic Gestation that occurs outside uterine cavity -- most Narrowing of fallopian tube Pain Expectant management - natural miscarriage
Pregnancy commonly in fallopian tube Hx of ectopic pregnancy - Unilateral pelvic pain/ shoulder pain Salpingectomy - most common
Abnormal bleeding/spotting - Remove pregnancy and fallopian tube
Shock Methotrexate
- Internal bleeding d/t fallopian tube rupture
Intrauterine Pregnancy lasts 9 calendar months, 40 weeks Nagele’s Rule: - calculate due date
Pregnancy from LMP, 280 days 1. 1st day of LMP
2. Subtract 3 months
3. Add 7 days
4. Add appropriate year
Intrauterine Babies with low birth weight + small for gestational Symm: rubella, chemical exposure, EtOH, drug use Symm: dec head + body size early in pregnancy ----
Growth age (symm + asymm) Asymm: HTN, DM, preeclampsia Asymm: head + body size vary later in pregnancy
Restriction
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Spontaneous Threatened - bleeding <20 wks --- cervix closed 1. Take a good hx
Abortions Inevitable - bleeding/cramping --- cervix dilated 2. Check cervix dilation
Incomplete - bleeding, cramping, passage of products of conception -- cervix dilated 3. Check fetal heartbeat or decline in hCG
Complete - firm uterus, passage of ALL products of conception -- cervix begins to close
Missed - fetal death in utero (has to be removed)
Recurrent - 3 spontaneous abortions
Induced Surgical - Medical - Watch out for Pt education
Abortions - Check for products of conception, bleeding - Methotrexate →ectopic pregnancy - Fever, chills, abd pain/cramping, Re-evaluate in 4-14 days
- Mifepristone → blocks progesterone prolonged/heavy bleeding, foul vaginal discharge Ask about further contraception
- Misoprostol → stimulate prostaglandin
GTPAL Gravida - # of pregnancies Term - # that last at least 37 wks Preterm - # that lasts 20-36.6 wks Abortion - # terminated before 20 wks Living - # of living children
(+) signs of Visualize fetus by US - 5/6 wks Vaccination Fundal Height + Gestation Leopold Maneuver
Pregnancy Hear heart tone by US - 6wks
Hear heart tones by doppler - 8/17 wks rH (-) → RhoGAM @28wks + post birth Top of uterus reaches umbilicus @20wks 1. Identify fundal contents
Palpate fetal movement - >20 wks - If mom Rh (-) → get father type Top of uterus reaches xiphoid @35wks 2. Locate fetal back
Visualize fetal movement - If both (-): do nothing 3. Identify what lies above pelvic outlet
- If dad (+): give Rh immune globulin 4. Identify cephalic + brow
(-) rubella → vaccinate post-birth
HBV during pregnancy
Complaints N/V → d/t hCG levels + changes in carb Urinary Frequency → pressure on bladder Fatigue → d/t pregnancy hormones Leukorrhea → d/t estrogen, inc vaginal secretion acidity
During metabolism Breast Tenderness → d/t pregnancy hormones + inc Heartburn → d/t progesterone + inc pressure
Pregnancy Syncope → d/t IVC sdr, supine hypotension sdr blood flow
Fetal Tests
Movement Health
- Mothers feel it at 16-20 weeks - Non-Stress Test
- Fetal Activity Monitor test can be done - Fetal monitor measures HR
- BPP used if non-reactive
- Growth Sono
- Done if fundal height does not match gestational age
- Dopplper
- Placental flow/health
OBSTETRICS COMPLICATIONS
Overview Cause S/S Tx
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