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139 Cards in this Set
- Front
- Back
When does beta-HCG peak and at what level?
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by 10 weeks gestation, peaks at 100,000mIU/mL
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Embryo
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fertilization until 8 weeks (10 weeks GA)
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Fetus
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8 weeks until birth
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Previable
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delivery before 24 weeks
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Preterm
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delivery between 24 and 37 weeks
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Postterm
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delivery beyond 42 weeks
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Gravity
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# of times a woman has been pregnant
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Parity
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# of pregnancies that have led to a birth at or beyond 20 weeks GA or weighing >500g
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TPAL
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# of Term, Preterm, Abortuses and Living Children
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Chadwick's sign
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bluish color of vagina and cervix
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Goodell sign
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softening and cyanosis of the cervix at or after 4 weeks
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Ladin sign
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softening of the uterus after 6 weeks
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Gestational age (GA)
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age in weeks and days since LMP
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Developmental age (DA)
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(conceptional age) is number of weeks and days since fertilization
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Nagle rule
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to calculate the estimated date of delivery:
LMP - 3 months + 7 days |
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Cardiac output
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increases by 30-50% during pregnancy (most during 1st trimester)
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Systemic vascular resistance
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decreases during pregnancy--causes fall in BP, probably due to increased progesterone causing smooth muscle relaxation
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Tidal Volume
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increases by 30-40% despite the TLC decreasing by 5% b/c of diaphragm rising
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GFR
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increases by up to 50% causing a BUN and Cr levels to decrease by about 25%
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Plasma volume
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increases by up to 50% but the plasma only increases by 20-30% so hematocrit decreases
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Hormones with the same alpha-subunit
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alpha-HCG, LH, FSH and TSH
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Human placental lactogen (hPL or hCS)
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made by placenta, important for fetal nutrition, causes lipolysis and increase in free fatty acids
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Normal weight gain
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20-30 lbs
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Protein requirement during pregnancy
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increases to 70-75g/day (from 60g/day)
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Calcium intake during pregnancy
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1.5g/day
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Folate requirement during pregnancy
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increases to 0.8mg/day (from 0.4mg/day)
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Maternal Serum Alpha Fetoprotein screening (MSAFP)
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usually between 15-18 weeks.
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Elevated MSFAP
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increased risk of neural tube defects
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Decreased MSFAP
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seen in some aneuploidies (including Down syndrome)
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Biophysical profile (BPP) components
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amniotic fluid volume, fetal tone, fetal activity, fetal breathing movements, and nonstress test (NST) of the fetal heart rate
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Fetal lung maturity measurement
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Usually use the lecithin to sphingomyelin (L/S) ratio. It should increase
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Lab tests for an ectopic pregnancy
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Beta-HCG should double approximately every 48 hours
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Medical management of uncomplicated ectopic pregnancies
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Methotrexate--in reliable patients due to necessary follow up
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Incidence of ectopic pregnancies
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1%
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Spontaneous Abortion (SAB)
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before 20 weeks gestation
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Abortus
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fetus lost before 20 weeks, less than 500g, or less than 25cm
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Complete Abortion
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complete expulsion of all the POC before 20 weeks gestation
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Incomplete Abortion
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partial expulsion of some but not all POC before 20 weeks' gestation
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Inevitable Abortion
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no expulsion of products, but bleeding and dilation of cervix such that a viable pregnancy is unlikely
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Threatened Abortion
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any intrauterine bleeding before 20 weeks, without dilation of the cervix or expulsion of any POC
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Missed Abortion
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death of the embryo of fetus before 20 weeks with complete retention of POC; these often proceed to complete abortions in 1-3 weeks but are sometimes retained for much longer
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Treatment of incomplete, first trimester abortion
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expectant management, D&C, or prostaglandins (misoprostol)to induce contractions and cervical dilation
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Incompetent cervix
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Painless dilation and effacement of cervix, often in 2nd trimester--causes ~15% of 2nd trimester losses. Can lead to infection, PTL or PPROM
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Cerclage
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suture placed vaginally around the cervix to close it--one possible treatment for an incompetent cervix
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Recurrent pregnancy loss
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3 or more consecutive SABs
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Sickle cell disease
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AR, single point mutation in gene for beta chain in hemoglobin
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Tay-Sachs disease
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AR, deficiency of hexosamindase A (hex A)--buildup up Gm2 gangliosides in lysosomes, esp. in brain
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Beta-thalassemia
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Sx seen several months after birth when beta would normally replace gamma chains
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Alpha-thalassemia
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Hb Bart (4 alleles)
HbH (3 alleles) Alpha thal trait (2 alleles) (1 allele)-mild microcytic anemia |
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Triple Screen
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MSAFP, estriol, beta-hCG
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Quad Screen
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MSAFP, estriol, beta-hCG PLUS inhibin A
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1st semester Down Syndrome screen
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Ultrasound for nuchal translucency (NT)and serum for free beta-hCG and pregnancy associated plasma protein A (PAPP-A) give an 80% sensitivity together
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Trimsomy 18
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Edward syndrome: die by 2 years old--can often be detected by US or triple screen. Clenched fists, overlapping digits, rocker bottom feet.
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Trisomy 13
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Patau syndrome: 85% die by 1 year. Similar signs as Trisomy 18. Can use US to screen but not triple screen.
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Turner Syndrome
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45X,0:
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Klinefelter syndrome
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47XXY
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Morula
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16 cells, by day 4
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Blastocyst
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Inner cells--embryo
Outer cells--trophoblast Implants in endometrium by end of day 7 |
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Trophoblast differentiation
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By start of week 2
give rise to placenta |
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Inner cell mass differentiation
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by start of week 2
divides into bilaminar germ disc (epiblast and hypoblast) |
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Gastrulation
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during 3rd week
formation of a primative streak on epiblast--invagination of epilbast cells into 3 germ layers |
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Endoderm layer
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GI and respiratory systems
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Mesoderm layer
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CV, musculoskeletal, and GU systems
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Ectoderm layer
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nervous, skin, and many sensory organs (hair, eyes, nose, ears)
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Neural Tube Defects
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develop d/t defective closure by week 4
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Spina Bifida
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can be seen with US, elvated MSAFP
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Eisenmenger physiology
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VSD causing RV hypertrophy, pulmonary HTN, eventual right-to-left shunt
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Tetrology of Fallot
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VSD
Overriding aorta Pulmonary Stenosis or atresia RV Hypertrophy |
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Potter Syndrome
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Bilateral renal agenesis causing anhydramnios, pulmonary hypoplasia and fetal contractures
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Nuchal Translucency (NT)
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screen for aneuploidy (Down in particular)--measures the posterior fetal neck in profile (~70% sensitive)
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Triple screen sensitivity alone
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60%
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3 ways to obtain fetal cells
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1-amniocentesis
2-chorionic villous sampling 3-fetal blood sampling |
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Amniocentesis
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after 15 weeks, can get fetal karyotype--place needle transabdominally thru the uterus into the amniotic sac to withdraw fluid (c sloughed fetal cells)
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Fluorescent in-situ hybridization (FISH)
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can ID aneuploidy from amniocentesis in 24-48 hours (normal culture takes 5-7 days)
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Risk of amniocentesis
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1 in 200
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Chorionic Villous Sampling (CVS)
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fetal karyotype sooner than amniocentesis--at 9-12 weeks. Place catheter in intrauterine cavity and aspirate chorionic villi from placenta
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CVS risk
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higher than 1 in 200
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Fetal Blood Sampling (via PUBS)
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needle placed transabdominally into uterus and phlebotomizing the umbilical cord
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Fetal Lie
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whether the infant is longitudinal or horizontal
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Fetal Presentation
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either breech or vertex (cephalic)
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PROM
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Premature rupture of membranes--at least one hour before onset of labor (occurs in 10%)
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PPROM
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Preterm, premature rupture of membranes--before 37 weeks
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Components of Bishop score
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1-dilation
2-effacement 3-fetal station 4-cervical position 5-consistency of the cervix |
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station
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relation of the fetal head to the ischial spines
0--presenting part is level wtih ischial spines--goes + from there |
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Cervical consistency
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firm, soft or in between
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Labor
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contractions that cause cervical change in either effacement or dilation
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Normal fetal heart rate
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110-160 bpm
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Early decelerations
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begin and end at approximately the same time as contractions--d/t increased vagal tone secondary to head compression
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Variable decelerations
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occur at any time and can drop more precipitously than early or late decels. D/t umbilical cord compression
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Late decelerations
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begin at peak of contraction and slowly return to baseline after contraction is over. D/t uteroplacental insufficiency--worrisome--may become brdaycardia as labor progresses
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External Electronic Monitor
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External tocometer--belt that goes around fundus--measures during contractions as belly gets firmer
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Fetal Scalp Electrode (FSE)
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more sensitive. C/I include hx of HIV or maternal hepatitis or fetal thrombocytopenia
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Intrauterine Pressure Catheter (IUPC)
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used if timing a/o strength of contractions is crucial. Catheter is threaded past presenting part into uterine cavity
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Cardinal movements of labor
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1-Engagement
2-Descent 3-Flexion 4-Internal rotation 5-Extension 6-External Rotation (restituion/resolution) |
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Engagement
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fetal presenting part enters pelvis
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Descent
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head descends into pelvis
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Flexion
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allows smallest diameter to present to the pelvis
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Internal Rotation
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from an occiput transverse (OT) position so that the sagittal suture is parallet to the AP diameter of the pelvis, often to the OA position
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Extension
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as vertex passes beneath and beyond the pubic symphysis
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External Rotation
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once head is delivered, so that shoulders can be delivered
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First Stage of Labor
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Onset until full dilation and effacement of cervix
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Second Stage of Labor
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From full dilation and effacement until delivery of infant
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Third Stage of Labor
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After delivery of infant until delivery of placenta
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Average time for 1st stage of labor
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10-12 hours for nulliparous
6-8 hours for multiparous |
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2 phases of 1st stage of labor
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Latent: onset until 3-4cm dilation with slow cervical change.
Active: until greater than 9cm of dilation, slope increases. |
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Factors affecting the Active Phase of the 1st Stage
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3Ps:
Powers: strength and size of contractions Passenger and Pelvis: babe may be too big for pelvis, etc (cephalopelvic disproportion-CPD) |
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Average time for 2nd stage of labor
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nulliparous: within 2 hours or 3 with epidural
multiparous: within 1 hour or 2 with epidural |
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Uterine hypertonus
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a single contraction lasting more than 2 minutes
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Uterine tachysystole
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>5 contractions in a 10-minute period
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Ritgen manuever
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moderate upward pressure on fetal chin with posterior hand while suboccipital region is held against pubic symphysis
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Time Frame for Placental Seperation
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usually within 5-10 minutes of fetal delivery but up to 30 minutes is normal.
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3 signs of placental separation
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cord lengthening, gush of blood, and uterine fundal rebound
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1st degree perineal laceration
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involves the mucosa or skin
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2nd degree perineal laceration
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extend into the perineal body but don't involve the anal sphincter
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3rd degree perineal laceration
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extend into or completely through the anal sphincter
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4th degree perineal laceration
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if anal mucosa is entered
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Pudendal nerve
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just posterior to ischial spine at its juncture with the sacrospinous ligament
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Epidural vs. spinal anesthesia
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Epidurals: more common during labor
Spinal anesthesia: one time dose, more rapid onset, more common with C-sections |
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Placenta Previa
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abnormal implantation of the placenta over the internal cervical os (complete, partial or marginal)--occurs in 0.5% of all pregnancies and accounts for 20% or all antepartum hemorrhages
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Vasa Previa
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rare, when a fetal vessel lies over the cervix
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Placenta Accreta
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abnormal adherence of the placenta to the uterine wall-causes inability of the placenta to seperate from the uterine wall after delivery
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Placenta Previa symptoms
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sudden and profuse painless vaginal bleeding, usually after 28 weeks gestation
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Circumvallate Placenta
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occurs when the membranes double back over the edge of the placenta, forming a dense ring around the periphery of the placenta--considered a variant of placental abrubtion
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Placenta Increta
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abnormal placentation where the placenta invades the myometrium
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Placenta Percreta
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Abnormal placentation where the placenta invades thru myometrium to the uterine serosa
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Velamentous Placenta
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When the blood vessels insert b/t the amnion and teh chorion, away from the margin of the placenta. Leaves the vessels unprotected and vulnerable to compression or injury
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Succenturiate Placenta
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An extra lobe of the placenta that is implanted at some distance away from the rest of the placenta. Fetal vessels may course between the 2 lobes, possibly over the cervix, leaving these blood vessels unprotected and at risk for rupture
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Placental Abruption (Abruptio Placentae)
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premature separation of the nornally implanted placenta from the uterine wall, causing hemorrhage b/t uterine wall and placenta--occurs in 0.5-1.5% of all pregnancies and is the cause of 30% of 3rd trimester bleeding
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Placental Abruption symptoms
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3rd trimester vaginal bleeding with severe abdominal pain a/o frequent, strong contractions. 20% have no symptoms d/t concealed hemorrhage.
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Apt test
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test for vaginal bleeding to see if fetal blood cells (nucleated) are present
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Low Birth Weight Infant (LBW)
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born weighing less than 2500g
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Tocolytic agent
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Ritodrine--only FDA approved drug for preventing contractions--can only prolong birth by ~48 hours
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Betamethasone
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a glucocorticoid used to enhance fetal lung maturity when PTL is anticipated
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Dehydration and contractions
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a dehydrated patient will have more ADH, which is similar in structure to oxytocin and also made in the hypothalamus--so correcting dehydration may reduce contractions
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Ritodrine MOA
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Beta-mimetic. Increases conversion of ATP-cAMP which decreases the levels of free calcium (via sequestration into sarcoplasmic reticulum ) which decreases uterine contractions
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Magnesium sulfate
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Decreases uterine tone and contractions by acting as a calcium antagonist and membrane stabalizer
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Calcium Channel Blockers
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especially nifedipine--decrease influx of calcium into smooth muscle cells--diminish uterine contractions
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Prostaglandin Inhibitors
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Indomethacin (NSAID)-used as a tocolytic--many potential fetal complications
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Rate of Preterm Delivery
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occurs in up to 10% of all pregnancies
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