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OB ATI: PART A: CHAPTERS 1-7-ANTEPARTUM

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1.

OB ATI

CHAPTERS
1-7
ANTEPARTUM

2.

TRIMESTERS

1. 1ST TRIM=1st day of LMP TO end of 13th


week
2. 2nd TRIM=Beg of 14th week TO end of 26th
week
3. 3rd TRIM=Beg of 27th week TO end of 40th
week

3.

TERMS

FULL TERM=End of 37 weeks to beginning of


42 weeks (END of 41 weeks=Full term)
PRE-TERM=Born before 27 weeks (but after 20
weeks because before 20 weeks is
miscarriage/abortion)
POST-TERM=Born after 42 weeks
POST MATURE=?

4.

LABS!!

HCT: M 42-52 F 37-47


HGT: M 14-18 F 12-16
RBC: M 4.7-6.1 F 4.2-5.4
WBC: 4500-1100
PLATELETS 140-400

5.

CONT'D

CHOLESTROL: LDL over 190 is bad, HDL


should be over 40 for M and over 50 for F
LDL=BAD HDL=GOOD
TRIGLYCERIDES: Less than 150 is normal
GLUCOSE: 75-115
MAGNESIUM: 1.5-2.5
NA: 134-145
K 3.5-6 3.5-5.5 (potassium)
CALCIUM: 8.5-10.5
CREATININE .6-1.2
BUN: 7-18

6.

ABG

PH: 7.35-7.45
PCO3 35-45
PCO2: 80-100
HCO3: 22-28 (BICARB)
*IF BICARB IS OFF, ITS METABOLIC
*IF PCO2 IS OFF, ITS RESPIRATORY

7.

CONT'D

PT: 12-14 sec


PTT: 60-70 sec
aPTT: 20-35 sec
DDimer: <250
INR therapeutic: 2-3

8.

CH 1
ANTEPARTUM
RN CARE

CH 1
ANTEPARTUM RN CARE

9.

OVULATION

-Occurs 14 days before mentstrul cycle


-START of fertile period=Subtract 18 days from
# of days in women's shortest cycle
-END of fertile period=Subtract 11 days from @
od days in longest cycle
-EX:
SHORTEST CYCLE: 26-18=8th Day
LONGEST CYCLE: 30-11=19th day
=Fertile Period is Days 9 through 19
*Refrain from intercourse during these days to
avoid contraception

10.

SPERM AND
OVUM

-SPERM: Viable for 48-120 hr


-OVUM: Viable for 24 hr

11.

CALENDAR
METHOD

-Most useful when combined w basal body


temp or cervical musuc method

12.

VARIOUS
BC

-BASAL BODY TEMP: Drops slightly during


ovulation (measure in AM)
-MUCUS: Mucus gets thin and less acidic during
ovulation; greatest ability to stretch bw fingers is
during ov (Spinnabarkeit sign)
-DIAPHRAM: Refit Q2 yr, after baby, 15 lb
weight change, or after 2nd term abortion;
leave in 6 hr after; jelly applied to cervical side of
dome; empty bladder first; not for TSS pt,
-MINIPILL: Fewer side effects than combined
oral-cont, inc ov cysts, dec lipido and
breathrough, inc appetite; irregular vag
bleeding; (this is oral progestin)
-911 AM AFTER: Take w/i 72 hour, see MD if no
period is 21 days, can get if over 17

13.

CONTD

-PATCH: Replace 1x/week; Patch applied same


day of week for 3 weeks w no applicatoin on 4th
wk; same side effects/risks of oral BC
-DEPO-PROVERA: Inj every 11-13 wk; 1st one
given during 1st 5 days of p'; in PP NON-BFing,
inj given within 5 days of delivery; for BF, start
in 6th wk; need calc and vit D; 4 inj/yr; do not
massage inj site
-NUVARING: Ring replace Q 3 weeks, and new
ring w/i 7 days; insertion on same day q month;
does NOT nee to be fitted;
-INPLANOL: Minor surgical px; good for 3 yr;
can use if BFing after 4 wks; headahce and
irregular menses
-UID: T-Shape; placed in uterus; MOnitor
monthly by pt adter period to make sure small
string there; effective 1-10 yr; safe for BF; inc
PID, ecpotic preg,

14.

CONT'D

-TRANSCERIVCAL STERILIZATION: Insertion


of small agents through vag; develops scar
tissues in tubes; need exam after 3 mo; NOT
REVERSIBLE; effective in 3 3 mo; changes in
menstration
-TUBAL LIGATOIN: Severance or blocking
fallopian tubes; cut burn or block
-MALE VASECTOMY: Cut vas def; need alt BC
for 20 ejaculations or 1 week to several mo to
clear the vas def; scrotal support for few days;
follow up for sperm count

19.

PROBABLY

(CAN be caused by other than preg)


-Abdon englarment
-Hegars Sign (Softening and compressoin of
lower uterus)
-Chadwicks Sign (Bluish violet color of cervix and
vag mucosa)
-Goodells Signs (Softening of cervical tip)
-Ballottment (Rebound of engaged fetus)
-BH Cont (Faslte, painless, irreg)
-+ Preg test
-Fetal outlike felt by examiner

15.

CH 2
INFERTILITY

CH 2
INFERTILITY

20.

POSITIVE

16.

STUFF

-40% due to males-cheaper to check them


first so we do
-Due to endometriosis, SAB, surgeries in
pelvic or abdom areas, STIs, teratogenic shit,
mumps during teens for males, substance
use
-Hysterosalpinography-Uses dye to look at
patency of fallop tubes; CANT HAVE w
seafood allergy
-ECTOPIC=Implants in fallop tubes due to
precense of endometrial tissue; If dx'ed
before rupture of tube, then surgical removal
is poss or give methotrexate (rhteumatrex) to
dissolve it
-Use of meds to treat F infertility may inc
chance of multiples by 25%
-Genetic counseling: sickle cell anemia or
sickle cell trait
-Only referred to genetic counseling for birth
defects of physiological concerns (VWD,
anemia, sickle cell)

(Signs exaplined ONLY By preg)


-Fetal HS
-Visualization of fetus on US
-Fetal movement palpated by MD

21.

PREG TEST

-hCG
-Px can start on day of conception
-Detected 7-10 days in serum after conc
-hCG peaks 60-70 days gest, declines until day
80, then INC til term
-Higher hCG=Multiples, extopic, hydatilform
mole, or genetic abnorm like DS
-Lower hCG=Miscarriage
-False Pos or False Neg: Anticonvulsants,
diuretics, tranquolziers

22.

GTPAL

-Remember, G is included in current preg!


-Parity=# that made it to viability
GTPAL: P=Preterm 20-37 weeks
T=TERM births over 38 wk

23.

GTPAL

G=Gravida
T=Full term (completion of END of 37th week to
END Of 42 weeks)
P=Pre term (After 20th week but before start of
38th week)
A=Abortions or miscarriages before 20 weeks
L=Living children

24.

TERMS

-GRAVIDA=# of Pregnancies
-PARA=# of VIABLE Pregnanices
-VIABLE=20 weeks or greater
-NULLIGRAVIDA=Never pregnant
-PRIMIGRAVIDA=1st time preg "primit"
-MULTIGRAVIDA=2 or more pregnanices
-PRIMIPARA=1st viable pregnanices
-MULTIPARA=2 or more viable preg (babies
delivered after 20 weeks either dead or alive)
-NULLIPARA=Woman has not px'ed any viable
offspring

25.

CHANGES

1. CV: CO and BV inc 45-50%; HR inc


2. RESP: 3rd trim, size of chest inc, RR inc
3. GI: NV, const
4. REANL: GFR inc, amt urine px remains SAME;
urinary freq
5. ENDO: Placenta px estrogen, progesterone,
hpl, portalgandins, hCG

17.

18.

CH 3
NORMAL
CHANGES
DURING
PREG

CH 3
NORMAL CHANGES DURING PREG

PRESUMPTIVE
SIGNS

-Amennorhea
-Fatigue
-N/V
-Urinary freq
-Breast changes
-Quickening (slight flutter of fetus around 1620 wk)
-Uterine enlargement
-Montgomerys Glands

26.

EXPECTED
VS

1. BP: Same 1st trim, 2nd trim: dec 5-10 (S &D),


after 20 wk, BP returns to same
-SUPINE: BP lower bc of uterus on vena cava
pressure so hypotension and fetal hypoxia; s/s;
put wedge under 1 hip if must be in supine but
best are L lateral, semi-fow
2. PULSE: Inc 10-15 around 20 wj and stays high
for rest of preg
3. RESP: Inc 1-2 bc of higher diaphram by 4 cm;
some SOB
-S1 S2 S3 may be heard better after 20 wk bc of
bigger heart which returns to normal after
delivery
-Uterus changes from 50 g to 1000 g!!
-36 wk, uterus reaches xiphoid proc (SOB)
-CHOLASMA=Pig inc on face

27.

NUTRITOIN

-Weight gain 25-35 b


-Inc cal 300-400/day
-Inc protein by 25 g/day
-Iron intake 30 mg/day
-Folic 600 mcg/day

CH 4
PRENATAL
CARE

CH 4
PRENATAL CARE

29.

VISTIS

-Monthly until 7 mo
-Q 2 weeks 8th mo
-Q week 9th mo

30.

ONGOING
VISITS

-Weight, BP, uterine for bg, protein and


keytones
-Presence of edema
-FHR dev: Doppler at 10-12 wk, US stetheccope
16-20 wk: listen at ML above symphis pubis
-Measure funal height after 12 wk gest
-Assess for fetal movemnt 16-20 wk

28.

31.

COOMBS
TEST

-Rh
-For pt who are Rh neg and not sensitized, its
repeated bw 24-28 wk

32.

ROUTINE
LABS

-Rh
-CBC w diffential (for inf)
-Hgb Hct (for anemia)
-Hgb electrophoresis (for sickle cell and thallasmia)
-Rubella titer
-Hep B screen
-Group B Strptococc at 35-37 wk
-Urinalysis (DM, gest HTN, renal dis)
-PAP for cerv cancer
-PPD after 20 wk chest xray
-VDRL-Syphyllis screen
-HIV-rec for all unless refuse
-TORCH: Toxoplasmosis, other, Rubella,
Cytomegaolvirus, and Herpes-all cross placenta
and adversely affecet fetus
-Maternal serum alpha-fetoprotein MSAFP-Screen
bw 15-22 wk to rule out DS

33.

MSAFP

-LOW LEVEL=Down synd


-HIGH LEVEL=NTD
-MD may opt for quad screen instead of MSAFP, at
16-18 wk which includes AFP, Inhibin-A, combo of
hcg and estriol

34.

GLUCOSE
TESTS

1 HR GLUCOSE TOLERNACE:
-Done at 1st visit for high risk
-Done at 24-28 for ALL
-Over 140 requires follow up
-Fasting NOT necessary
3 HOUR GLUCOSE TOLERANCE
-Fasting necessary
-Take 1 2 and 3 hr
-For high 1 hr levels
-Need 2 highs for gest diab

35.

RHOGAM

-Give to mom at 28 wk if she is RH-NEG!!

36.

HEALTH
PROMO

-No hot tubs or sauanas


-30 min/day exercise
-2-3 L a day water
-KICK COUNTS: Cont 2-3 times a day for 60 min
each time; less than 3 movements per hour or no
movement for 12 hr needs further investaging
-N/V: Eat toast or dry crack 30 min before getting
out of bed;
-Urin freq=1st and 3rd trim
-Heartburn: 2nd and 3rd: from inc progesterone
and slow GI tract motility and dig
-Constpat: 2nd and 3rd-eat high fiber
-Hemrrhoids: 2nd and 3rd: Sitz baths, witch hazel
pads, and topical ointment

37.

CONT'D

-Leg cramps: 3rd trim: dorsiflex foot and use


heat
-Varicose veins and LE edema: 2nd and 3rd:
support hose, elevate legs, walk a lot, dont cross
legs
-Gingivitis, nasal stuffy and epistaxis
(nosebleed); bc of inc estrogen causing inc
vascularity and proliferation of CT; brush gently,
see dds, normal saline nose drops
-Hypotension: from uterus compressing vena
cava; s/s=dizzy, lighteadnes , faintness-side lying
or semi-sit w knees flight flexed

38.

FEELINGS

AMBIVALENCE-1ST
ACCEPTING-2ND
PREPARING-3RD

39.

DANGER
SIGNS:

COULD INDICATE GEST HTN:


-Severe headhaces, blurred vision, edema of
face and hands, epigrastric pain
HYPERGLYCMEIA
-Fruity breath, flushed dry skin, rapid
breathing, inc third and urination, and
headhace
HYPOGLECYMAI
-Clammy pale skin, weak, tremor, irriabiloity, and
lightheaded
UTI
-Dysuria (painful peeing)
ABD PAIN
-Abrupt, PML, ectopic

42.

ETC

-2nd trim: Inc cal by 340/day


-3rd Trim: Inc cal by 452/day
-If BF: Inc cal by 330/day for 6 mo, after 6 mo,
inc by 400/day
-FOLIC ACID FOODS=Leafy veg, dried peas
and beans, seeds, OJ, breads cereal and grains
-Take 600 mcg during preg, take 500 mcg if
lactating
-Iron: Best absorbed bw meals and WHEN
GIVE W VIT C!! (OJ) Milk and caffeiene interfere
w iron abs; IRON=Beef liver, red meats, fish,
poulty, dries peas beans, fortificed ertal and
bread; may need laxie bc of iron suppsl
-CALCIUM: 1000 mg/day for pre and non preg
over 19, 1300 is under 19 yr old
-2-3 L fluid a day-water fruit juice milk
preferred
-No more than 300 mg/day caffeine (500-750
can inc SAB and IUGR)

43.

CONT'D

-Vegetarians may be low in protein, calc, iron,


zinc, and vit B12
-If N/V-DO NOT DRINK FLUIDS while eating
and NO MEDS for nausea without asking MD
-Const: INC FIBER

44.

PKU

=Maternal Phenylkeoturinea=Maternal genetic


dis w high levels of pehnylathine
-Resume PKU diet 3 mo before preg and for all
of preg
- DIET=foods low in phenyaline
-AVOID foods high in protein (fish, poultry,
eggs, meat, nuts dairy-all have HIGH
PHENYALINE
-Blood pehnylalanine levels monitoring during
preg
-Can make maternal retardation and beh
probs if dont follow above interventions

45.

CH 6
ASSESSMENT
OF FETAL
WELL BEING

CH 6
ASSESSMENT OF FETAL WELL BEING

46.

TESTS

1. US
2. BPP
3. NST
4. CST
5. AMNIOCENTESIS

47.

HIGH RISK
PREG TESTS

1. PERCUTANEOUS UMB BLOOD SAMPLING


2. CHORIONIC VILLUS SAMPLING
3. ALPHA-FETOPROTEIN (AFP) AND QUAD
MARKER

*ROM should be AFTER 37 weeks


40.

CH 5
NUTRITION

CH 5
NUTRITOIN

41.

WEIGHT
GAIN

-25-35
-1ST TRIM: Gain 1-2 kg (2.2-4.4) lb
-2ND AND 3RD TRIM: .4 lg (1 lb!!) / week
-If underweight: Gain 28-40 lbs
-If overweight-gain 15-25

*Be able to calc: 3-4 lb in 1st trim, then 1 lb/week


after that to have a total

48.

TESTS
BY
TRIM

1ST:
-CHORIONIC VILLUS
2ND:
-US
-AFP
-QUAD
-AMNIOCENTESIS
3RD:
-NST
-BBP
-US

49.

1. US

-Abdom: more useful after 1st trim when uterus larger


-Vag: does not require full bladder; good for obese, 1st
trim to detect epotopic, ID abnormal, and establish
gest age; useful in 3rd trim w abdom scan to evalute
for PTL
-Doppler-non invasic, looks at maternal fetal blood
flow, useful for IUGR and poor placental perf, and as
adjunct in risk preg bc of HTN, DM, multiples, or PTL
INDICATIONS/POTENTIAL DX
-Confirm, gest age, multiple, site of fetal implant
(uterine or ectopic), fetal growht and dev, maternal sx,
confirm vaibility or death, rule out abnormal, site of
placental attach, determine amn fluid V, fetal
movement (H beat and breathing), placental grading,
-Drink 1-2 Q fluid before, supine pos w wedge
-Pee at END

50.

2.
BBP

-Real time US to visualize physical and pshioglocal char


of etus
-Assess fetal well being w score of 2 for each normal
and 0 if not:
1. REACTIVE FHR (NST)=2, NON RX=0
2. FETAL BREATHING MOVEMENTS (AT LEAST 1
EPISODE OF 30 SEC OR MORE IN 30 MIN)=2, ABSENT
OR LESS THAN 30 SEC=0
3. GROSS BODY MOVEMENTS (AT LEAST 3 LIMB EXT W
RETURN TO FLEX IN 30 MIN=2, LESS THAN 3=0
4. FETAL TONE (AT LEAST 1 EPISODE OF EXT W
RETURN TO FLEX) **no timing here**=2,
SLOW/LACK/NONE=0
5. AMNIOTIC FLUID VOL (AT LEAST 1 POCKET AT
LEAST 2 CM IN 2 PERPENDIVULA PLANES=2, POCKES
LESS THAN 2 OR ABSENT=0

51.

CONT'D

-8-10 normal=low risk of fetal asphyxia


-4-6 abrmomal=suspect chronic fetal asphyxia
-Less than 4=abnoromal=strongly suspect " " "
POTENTIAL DX
-Nonreactive stress test
-Oligohyramniosos or polyhydramniosis
-Suspected fetal hypoxemia and/or hypoxia
CLIENT PRESENTATION
-PROM
-Maternal inf
-Dec fetal movement
-IUGR
RN AX
-Prepare using same as US

52.

3. NST

-Most widely use for antepartum eval of fetal well


being
-3rd trim
-Measures response of FHR to fetal movement
-Doppler transfucer and tocotransudcor attacked to
abd; pt pushes button when sheels movement
POTENTIAL DX FOR
-Asessing for intact fetal CNS during 3rd trim
-Ruling out risk for fetal death in pt who have DM;
used twice a week or until 28 wk gest
CLIENT PRESENTATION
-Dec fetal movement, IUGR, postmaturity, dest DM,
gest HTN, maternal chronic HTN, Hx of previous
fetal demise, Advanced maternal age, Sickle cell dis,
isoumminzation

53.

CONT'D

-REACTIVE=If FHR is normal BL w mod variability,


accelerates 15 bpm for 15 sec and happens 2 or
more times during a 20 min period
-NONREACTIVE=FHR does not accelerate
adequately w fetal movement; does not meet above
criteria after 40 min
-IF NONreactive-need PPB or CST
RN PREP:
-Semi fow or L lat
-2 belts
-If no movement, fetus sleeping, vibroacoustic stim
can be used-laygeal stim-on moms abd over fetal
head for 3 sec
DISADVANTAGE
-High rate of false nonreactive blunted by sleep,
fetal immaturity, maternal meds, and chronic
smoking

54.

4. CST

-Nip stimulated-brush palm across nip for 2 min


which casues pit to lease oxytocin and then stop stim
when contr beings
-Repeated after 5 min rest period
-FHR response to contr measured
-At least 3 contr w/i 10 m in w duration of 40-60 sec
MUST BE OBTAINED for data coll
-Avoid hypterstim of uterus (cont longer than 60 sec
or more than q 2 min) (dont use bimanial stim)
-If fails, use oxytoxin admin IV-BUT cant be hard to
stop and result in PTL
POT DIAGNOSIS
-High risk preg (Gest DM, postterm)
-Nonreactice stress test
CLIENT PRESENTATION
-Dec fetal movement, IUGR, postmaturity, gest DM,
gest HTN, chronic mat HTN, hx of pervious fetal
demise, advanced mom age, sickle cell dis

56.

5. AMNIOCENTESIS

=Aspiration of amn fluid


-14 wk after gest
POTENTIAL DX
-Previous birth w chromonal anoamly
or parent who is carrier
-Fam hx of NTD
-PRenatal dx of genetic dis or cong
anomal
-AFP level for fetal anoml
-Lung maturity assessment
-Fetal hemolytic dis
-Meconium in amniotic fluid
-HIGH LEVELS=NTD (encelphalopahy,
spina bifida, omphalocele), or with
multiples
-LOW LEVELS=Chromoson disroders
(Downs) or gestational trophoblastic dis
(Hydatifiform mole)

55.

CONT'D

-NEGATIVE=NORMAL!!=If within 10 min, W/ three


UCs, there are NO LATE DEC of FHR
-POSITIVE=ABNORMAL!=If persistent and consistnet
lace deel on more than half of the UCs; suggests
uteroplacental insuff
-Var deceler: cord compression
-Early decel: Head comp
-Based on findings, MD may induce labor or order
C/S
RN PREP:
-Baseline FHR, fetal movement, and UC for 10-20
min
-Roll nip bw thumb and fingers or brush palm
across-stop when UC begins
IF HYPERSTIM OF UC: Tocolytics, bed rest during px,
observe for 30 min after to see theyve stopped and
labor doesnt start
DISADVANTAGE
-Potential for PTL

57.

CONT'D

-Can test amn fluid at less than 37


weeks if PTL, ROM, or complicaitons to
see if fetal lungs are ok
FETAL LUNG TEST
-LEcithin/Sphinogmyelin (L/S): 2:1 ratio
indicating fetla lung maturity
-Presence of phosphatydaglycerol (PG):
Absense=fetal resp distress
RN AX
-Empty bladder first
-Supine
-Need US to lx placenta
-Cleanse abdomen before local ana
-Do not hold your breath
-Rest 30 min after
-GIve Rhogam is shes Rh NEG

58.

HIGH RISK

1. PERCUTANEOUS UMB BLOOD


SAMPLING
2. CHORIONIC VILLUS SAMPLING
3. ALPHA-FETOPROTEIN (AFP) AND
QUAD MARKER

59.

1. PERCUTANEOUS
UMBILICAL BLOOD
SAMPLING

-Use US to get blood from umb cord


BLOOD STUDIES FROM
CORDOCENTESIS MAY CONSIST OF:
-Kleihause-Betke tet to ensure fetal
blood obtained
-CBC w diff
-Indirect coombs for rh antibodies
-Karotyping (visualization of chromos)
-Blood gases
POTENTIAL DX
-FEtal blood type, RBC, and
chromosonal dis
-Karotyping and malformed fetus
-Fetal inf
-Altered acid base balance of fetus w
IUGR

60.

61.

2.
CHORIONIC
VILLUS
SAMPLING

3. QUAD OR
AFP

-Assess developing placenta aspirated


transvag or through abd wall
-1st trim alternative to amniocentesis w
ADVANTAGE of earlier dx of abnormalities
-10-12 wk w rapid results in 24-48 hr
POTENTIAL DX
-Women at high risk for giving birth to baby
who has genetic chromosonal abnormal
(canot determine spina bifida or
anencephaly)
RN ED
-Drink lot of water to fill bladder
*Higher risk for SAB than amniocentesis

69.

BLEEDS
BY TRIM

1ST TRIM:
1. SAB
2. ECTOPIC PREG
2ND TRIM:
3. GEST TROPHOBLASTIC DIS
3RD TRIM:
4. PLACENTA PREVIA
5. PLACENTA ABRUPTO

70.

1. 1ST
TRIM:
SAB

S/S=Vag bleed, uter cramp, partial or complete


expulsoin of px of conc, backache and abd
tenderness, ROM and dilation, fever, hypotension
and tachy (ss of hem)
=When preg term before 20 wk or before fetus less
than 500 g
TYPES:
1.THREATENED=w or w/o cramps, spot-moder
bleed, no tissue passed
2. INEVITABLE=Mod cramps, mild-sever bleed, no
tissue passed
3. INCOMPLETE=Severe cramps, cont and sever
bleed, partical fetal or plac passed
4. COMPLETE=Mild cramps, minimal bleed,
complete pass
5. MISSED=No cramps, brown d/c bleed, no pass

71.

RISK
FACTORS
FOR SAB

-Chromosonal abnorml (50%)


-DM
-Mom age
-Premautre cervi dil
-Mom inf or malnutrition
-Trauma/injury
-Anoamlies
-Substance use
-Anitphospholipid syndrome

72.

DO

-Hgb, hct, WBC, Hcg, clotting factors, US,


-D&C=Dilate and scrape uterine walls to remove
uterine contents for ineveitable and incomplete
-D&E=Dilate and evacuate uterine contents after
16 wk gest
-Pitocin and prostalgandings
-Antibiotic for septic abortion
-RHOGAM!
-D/C normal for 1-2 wk
-No sex or hot tub 2 wk
-Do not get preg for 2 months!!

QUAD=4 marker screen that tells liklihood of


fetal birth defects
-Does NOT dx actual defect; can do intead of
AFP to give better results
TESTS FOR:
1. Hcg (px by plac)
2. AFP (px by fetus)
3. Estriol (px by fetus and plac)
4. Inhibin A (Px by ovaries and plac)
-16-18 wks
PT PRESENTATION
-Women at high risk for giving birth to baby
who has genetic chromosonal abnormal

62.

CONT'D

FINDINGS
-LOW AFP=Risk for DS
-HIGH AFP=Risk for NTD
-HIGHER hCG and INHIBIN=Risk for DS
-LOWER ESTRIOL=Risk for DS

63.

AFP

AFP (its actualy MSAFP)


-Screening tool for NTDs
-ALL preg clients, bw 16-18 wk
FINDINGS
-HIGH AFP=NTD or open abd defect
-LOW=Down Syndrome

64.

L/S

=Test for fetal lung maturity!

65.

AFP

-Test for NTD and chromononal dis

66.

KLEINHAUERBETKE TEST

-Verifies fetal blood is present

67.

COOMBS

-Detects Rh Anitbodies in mom's blood

68.

CH 7
BLEEDING
DURING
PREG

CH 7
BLEEDING DURING PREG

73.

74.

2. 1ST TRIM:
ECTOPIC

2. 2ND TRIM:
GESTATIONAL
TROPHOBLASTIC DIS
-HYDATIDIFORM
MOLE (=RARE MASS
OR GROWTH IN
UTERUS)
CHORIOCARCINOMA
-MOLAR
PREGNANCY

-Ovum in fallop tube usually can result


in tubal rupture and fetal hemor
-Risk factors: IUD, STIS, tubal surgery,
repo tech
S/S=Unilateral stabbing in LQ, delayed
(1-2 wk) lighter than usual mesnse,
scant dark red or borwn spotting,
shoulder pain, faintness, dizzyness,
signs of shock (hypotension, tachy,
pallor) (<-- those are the OBJ signs),
-Need progesterone and hcg levels
DO
-SALPINGOSTOMY=To salvage tube if
not rupture
-LAPROSCOPIC " " =Removal of tube
when ruptured
-METHOTREXATE (MTX)-Inhibits cell
div and embryo enlargement,
dissolving the pregnancy (avoid folic
vitamins and alcohol if on this), protect
self from sun
1. COMPLETE MOLE=No gen material,
no fetus place amn fluid or
membranes, no placenta
2. PARTIAL MOLE=Div didnt occur,
abnormal parts, a sac, fetal blood, but
anomalies present
RISKS=Low carotene of animal fat
intake, age-teens or over 40, ovulation
stimuation w clomiphene (Clomid)
-Exessive vomiting, dark brown bleed,
s/s of preeclampsia, hcg HIGH and
decline 10-12 wk of preg,
DO
-US, suction curretage, hcg weekly for
3 wk, then monthly for 6 mo-1 yr to
detect GTD
-RHOGAM if RH neg
-Chemotherapuetic meds

75.

3. 3RD
TRIM:
PLACENTA
PREVIA

-Placenta over OS
-Results in bleed during 3rd trim
-Marginal or low lying previa-placenta attached in
lower uterine but does not reach cervical os
RISKS=Uterine scarring, age 35-40, multiples,
closely spaced pregs, smoking
S/S=Painless bright red bleed, soft uterus
nontender, fundal heigh greater than expected,
breech oblique or transverse fetus, reassuring
FHR, VS within normal limits, dec UO
DO
-Leopalds
-Lung steroid (betamethasone) if delivery
anticiaptd (C/S)
-IV fluids, blood, meds

76.

4. 3RD
TRIM:
PLACENTA
ABRUPTO

-Premature separation of placenta from uterus,


which can be partial or complete
-After 20 wk gest
-LEADING CAUSE OF MATERNAL DAETH
-DIC assoc w this
RISKS=HTN, trauma, cocaine, cigs, PROM,
multiples
S/S=Sudden onset intense pain dark bleed,
uterine tender, hypertonic UC, fetal distress,
hypovolemic shock signs
DO
-IV, blood, meds
-Lung steroid (betamethasone) if delivery
anticiaptd
-O2 8-10 L
-UO
-Prolonged PTT
-Dec fibrinogen
-Dec platelemts
-Clot time NORMAL!