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normal adult HR

70 (range 60-100)

Oral temp rage

33.2-38.1

Rectal temp range

36.8-37.1

Tympanic temp range

35.7-37.5

temp in pregnancy

-0.3°C (0.5°F) decrease in first trimester
-further decrease of 0.1°C (0.2°F) per month through 37 wk

increases HR

pain, fear, pyrexia, exercise, hemmorhage, anemia

HR in pregnancy

increases 10-20 bpm

respiration in adults

12-20 /minute

respiration in pregnant women

12-20/ min (Rate unchanged, Depth greater,
Breathing largely diaphragmatic)

normal BP in adults

100/60 - 140/90mmHg

Blood Pressure in Pregnancy

-decrease steadily until 20 weeks
-then increases until delivery
-average increase of 8 % between mid gestation & delivery

I.M. injection

-21 gauge
-90 degrees
-syringe 3 ml/cc
-deltoid (1")
-vastus lateralis (1.5 ")
-rectus femoris (1.5 ")
-gluteus maximus (1.5 ")
-oxytocin

Subcut. Inject

-25g small needle
-45 degrees
-1"
-syringe 1-3 ml/cc
-into fat and conn. tissue
-insulin, haparin
-slowly absorbed b/c not in muscle

Intradermal Injection

-25 gauge
-10-15 degrees
-5/8 or 3/8 "
-syringe 1 ml/cc
-bevel upwards so small wheal forms and is seen on the skin
-sterile water

naegele's rule

subtract 3 months, add 7 days to first day of LMP

breast tenderness

week 5-7 after LMP

chadwick's sign

wk 6-8

goodell's sign

wk 8

hegar's sign

wk 8-10

NVP

-starts around week 8 (as early as wk 6)
-worse by week 10
-better by week 12
-gone by week 14

quickening

wk 17-20

hear heart with doppler

week 10-12

fundus at umbilicus

week 20

U/S dating - up to 12 wk

+/- 3 days

SIPS 1

10-13 +6
-best at 10+2-11+6

SIPS 2

15-20+6
-best at 15+2-17

NT scan

11-13+6
best done at 12-13+3

SIPS 1 measures

PAPP-A (Pregnancy Associated Plasma Protein A)

SIPS 2 measures

a) AFP (alpha-fetoprotein)
b) unconjugated estriol (uE3)
c) hCG
d) inhibin-A

CVS

11-12+6 weeks

detailed ultrasound

18-20 wk

GBS screen

35-37 weeks

blood vol increase

30-50%

number of chromosomes in a gamete

23

number of chromosomes in a regular cell

46 (23 pairs)

incidence of PP blues

50-80%

incidence of PPD

15%

incidence of PP thydroiditis

5-10%

incidence of pp psychosis

2-3/ 1000

fetal HR 12-20 wk

-160
-regular rhythm

fetal HR 0-12 weeks

-<90bpm until approx 10 wk

heart neurologically functioning by

16 wk

fetal HR 20-30 weeks

-150-155 bpm

Labour: song of the heart

-good variability (> 5 bpm)
- unchanged rate from previous baseline
- Baroreceptor response frequent

zygote arrives in uterus

-day 3-5 from conception, 17-19 from LMP (about 2.5 weeks)

implantation begins

- day 6 after conception (stables & rankin)
- day 20 after LMP (around 3 weeks)

zygote begins producing hCG & decidua secretes glycogen

-3 weeks from LMP

yolk sac making RBCs & cardio system starting to form

-4-5 weeks from LMP

fetus most vulnerable to teratogens

-wk 3-8 (embryonic period)

hcg falls

-wk 8-12 b/c placenta now able to make est & progest, corpus luteum no longer needed

organogenesis starts

-5 wk from LMP

risk factors for PPH

-full bladder (can displace uterus)
-high parity
-overdistension of the uterus: multiples, polyhydramnios, large fetus
-fibroids
-antepartum haemorrhage
-prolonged labour w weak or uncoordinated contractions
-atony caused by drugs
- Inversion of the uterus
- fiddling with the uterus in 3rd stage
-coagulation/clotting defects
-retained products in the uterus( secondary PPH)

respiration in newborns

-30-60 per minute
-very irregular is normal - listen for a full minute

newborn HR

-110-160 bpm
-varies with respiration - count for a full minute

Lactogenesis I

-milk components first seen in breast tissue and colostrum expressed from the breast
-from mid-pregnancy until day 2 after birth
- physical changes in breast and & hormonal changes
-culminates in the initiation of lactation

Lactogenesis II

-'milk comes in'
-days 2-3 after birth until about day 8 when mature milk is established
-drop in progest, prolactin remains high

colostrum

-thick yellow fluid
-16th week of pregnancy _> 3rd and 14th day PP
-high density, low vol
-more protein, minerals and fat-soluble vitamins (A and K) than mature milk
-less lactose, fats and water-soluble vitamins
-more anti-infective agents
-facilitates good gut flora & passage of mec

Chloasma

-due to hormonal changes
-pregnancy mask, usually on face
-AKA melasma

1st trimester

-wk 1-13
-implantation
-embyronic period -> organogenesis
-fetus vulnerable
-body adapt to pregnancy, many complaints

2nd trimester

-wk 14-28
-spinal cord closed by end
-baby growing tissues rather than new organs
-often feeling better

3rd trimester

-wk 28-term
-rapid weight gain, fetus much larger
-fetus: fat, vernix, thicker skin, lungs maturing
-mother may become uncomfortable again

microcytic anemia

-small RBC
-caused by iron deficiency

macrocytic anemia

-large RBC
-caused by folate deficiency, or B12 deficiency, chemotherapy

labour

progression of contractions, dilation of the cervix leading to birth of the baby, expulsion of the placenta and membranes

prodromal labour

-'non-progressive'; before dilatation really begins
-body's preparation for labor
-not everyone is aware of this stage, some women feel it more than others

lightening is due to

thinning of the lower uterine segment, allows more room for the head to descend

pelvic brim

-widest diameter: transverse (13.5 cm)
-anteroposterior: 11 cm
-oblique: 12

pelvic cavity

-considered circular: all diameters equal (12 cm)

pelvic outlet

-widest diameter: anteroposterior diameter (13.5)
-transverse: 11 cm
-oblique: 12 cm

station

- presenting part in relation to ischial spines

how often do you listen to the FHR: 1st stage

every 15min

how often do you listen to the FHR: 2st stage

every 5 min or after each contraction

take BP & temp

-every 4 hours in labour
-check temp every 2 hr if GBS+ or PROM

take pulse in labour

every hour

an abnormal HR in a mother

over 120, under 70

a abnormal HR in a fetus

baseline under 110 or over 160

some of the things newborn screen tests for

-Phenylketonuria (PKU)
-Maple Syrup Urine Disease (MSUD)
-Galactosemia (GALT)
-Cystic fibrosis (CF)
-Congenital Hypothyroidism (CH)

ideal time frame for prenatal screen

-after 24 hrs, day 2-3 is ideal

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