OB Exam 2 study guide

GTPAL
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Terms in this set (93)
GTPAL
Gravida, Term, Preterm, Abortions, Living

G- gravida, # of pregnancies

T- term, # of viable to term (37 weeks+) including stillbirths

P- preterm, births 21-36.6 weeks

A- abortion or miscarriage; 20 weeks and under

L= # living on that day
G/P
Gravidity: # of pregnancies

Parity: # of births carried to viability to at least 20 weeks, whether or not the fetus was born alive, stillborns included
Gravida
pregnant woman
gravidity
pregnancy
multigravida
a woman who has had two or more pregnancies
nullipara
a woman who has not completed a pregnancy with a fetus past 20 weeks, never given birth; this includes miscarriages or abortions before 20 weeks
multipara
a woman who has carried two or more pregnancies to 20 weeks
primigravida
a woman who is pregnant for the first time
primipara
a woman who has completed one pregnancy with a fetus that has reached at least 20 weeks
preterm
21-36.6 weeks
term38-42 weeksviabilityability to live outside the uterus over 20 weeks at least, most hospitals will consider 22-23 viablepostdate/posttermafter 42 weeksfertilizationsuccessful penetration of the egg by the sperm in the ampulla (second segment) of the uterine tubeimplantationThe process by which the zygote attaches to the uterine wall (approx 6-10 days after conception); placenta begins to form fertilized egg burrows into endometrium with the help of enzyme secretions from trophoblastthree main stages of fetal developmentgerminal stage embryonic period fetal periodgerminal stagethe 2-week period of prenatal development that begins at conceptionembryonic stageThe second stage of prenatal development, lasting from two weeks until the end of the second month. (8 weeks) most critical stage for development of organ systems and main external featuresFetal periodtime period from 9 weeks-birth rapid body growth/weight gain, differentiation of tissues, organs and systems less vulnerable than the embryonic stagepresumptive signs of pregnancybreast changes 3-4 wks amenorrhea @ 4 wks N/V 4-14 wks urinary frequency 6-12 wks fatigue 12 wks quickening 16-20 wksprobable signs of pregnancygoodwell sign (softening of cervix) 5 wks chadwick sign (violet/bluish color of cervix) 6-8 wks hegar sign (softening of lower uterine segment (6-12 wks) piskacek sign (uterine asymmetry) positive serum pregnancy test (4-12 weeks) positive urine pregnancy test (6-12 wks) braxton hicks contractions 16 wks ballottement floating upward 16-28 wkspositive signs of pregnancyfetal heartbeat fetal movement visualization of fetus seen at 5-6 wks fetal heart tones as early as 6 wksskin changes during pregnancylinea nigra: thin vertical line appears faintly at first, may become darker as pregnancy progresses, goes away postpartum edema: generalized edema of ankles and feet common; face or hands- call HCP, not normal "pregnancy mask" brownish blotches on skin around eyes; chloasma or malasma stria: stretch marks dry skin acne "pregnancy glow" (often caused by increase in blood volume and therefore blood flow, causing a "flushed" look)Naegele's ruleLMP - 3 months + 7 days (+ adjust year) or LMP + 7 days - 3 months (adjust for year) ex: LMP is 05/21/2019; EDD = 02/28/2020Discomforts of pregnancyN/V: use ginger, peppermint, crackers to alleviate ptyalism: excess saliva; spit extra in cup, use benadryl fatigue: get plenty of rest nasal congestion: saline spray leukorrhea: white/yellow discharge- wear a pantyliner if it feels excessive, cotton underwear, call HCP if foul odor occurs or itching and burning back pains: acetaminophen, stretch, rest, find positions while sleeping that are comfortable (like with a pregnancy pillow) urinary frequency dyspepsia, heartburn: bland diet, avoid spicy and acidic, or fatty foods; sleep with a slight incline flatulence constipation and hemorrhoids: increase water and fiber intake, sitz bath dental problems: gingivitis, floss/brush well and use soft bristle toothbrush leg cramping: elevation, supportive footwear dependent edema: elevation variscosities: elevation dyspareunia: difficult or painful intercourse; empty bladder fully, ice, warm bath, use water based lubrication, communicate pain to your partner nocturia: avoid drinking too much water before bed insomnia: practice good sleep hygiene, relaxation techniques round ligament pain: rest, change positions slowly, daily stretching hyperventilation, SOB: sit upright, rebreathe into paper bag, take deep breaths numbness, tingling in fingers: try wrist brace if necessary, stretch, alternative therapies, medication supine hypotensive syndrome: make sure to change positions slowlycervical mucus plugcan come out early, but isn't a sign of labor call HCP if bloody or yello/green, foul odor, or painvaginal and vulvar changesthickening of vaginal mucosa rugae edematous increased susceptibility to yeast infections pH: decreases from 6.0 to 3.5 vulvar hygiene pt education (avoid scented soaps)breast changesbreasts size increase and areola gets bigger and darkerneurological symptoms"pregnancy brain" decreased attention span poor concentration memory lapses carpal tunnel syndrom (3rd trimester) syncope- vagal, orthostatic hypotention pt education regarding changesheart changesposition: pushed upward, laterally to the left cardiac hypertrophy due to inc blood volume, cardiac output heart sounds: exaggerated 1st and 3rd, systolic murmurs HR increases 10-15 bpm blood volume inc means the body needs more iron, pt education stay hydrated and eat more proteinSupine hypotension syndromefrom laying on back after 20 to 24 weeks pressure from uterus decreases venous return to LE hypotension, dizziness, diaphoresis, pallor orthostatic hypotension stagnation of blood in LE encourage to rise slowly, keep feet moving while standingpostural changes during 3rd trimesterlumbar lordosis "waddle" gaitcalcium storagedecreased maternal serum calcium LE crampingBMI and its relation to appropriate weight gainsee following cards to see guidelines (BMI one side, recommended weight gain on other side)Underweight BMI <18.528-40 lbsNormal Weight BMI 18.5-24.925-35 lbsOverweight BMI 25.2915-25 lbsObese >30 BMI11-20 lbsFirst trimester patient educationschedule return visits general hygiene comfort measures anticipatory guidance sexual activity/restrictions physical activity alcohol/cigarettes/drugs discomforts and how to relieveSecond trimester patient educationreinforce previous teaching prenatal classes S/S preterm labor, when to call HCP discomforts and how to relievethird trimester patient educationS/S labor when to call HCP reinforce previous teaching labor or birthing class discomforts and how to relieveChildbirth educationprimary goal: to promote positive childbirthing experience A&P Comfort measures L&D process relaxation, pain management Lamaze: empowerment, dispelling myths, controlling breathing, position, massage, relaxation Bradley: inward relaxation, normal breathingDanger signs of pregnancyregular contractions indicating preterm labor, major decrease in fetal movement (less than 10 kicks/2 hours), edema in face or hands, headaches and vision changes, vaginal bleeding **teach to call provider**First trimester danger signssevere, persistent vomiting abdominal pain and vaginal bleeding indicators of infectionsecond trimester danger signsmaternal complications preeclampsia premature rupture of the membranes preterm laborthird trimester danger signsmaternal complications gestational diabetes placenta previa abruptio placentae fetal complications hypoxiaGeneral schedule for prenatal visits (well visit for low risk pregnancy)8-28 weeks: once every month 28-36 weeks: every other week (twice a month) 36-delivery: weeklyassessments done at each visitmom's VS, weight, fundal height, uterine growth, fetal heart tones, fetal movements and presentation McDonald's method for assessing fundal heightMcDonald's method (fundal height)a measure of the size of the uterus used to assess fetal growth and development during pregnancy. It is measured from the top of the mother's uterus to the top of the mother's pubic symphysisFirst prenatal assessmentbuild positive, nonthreatening relationship therapeutic communication (avoid medical, technical jargon) provide user-friendly service typically longer than other visits identify risks, modify risks, patient education, establish relationship & database, establish specific goals get as much info as possible including: biographical data, social hx, psych assessment, OB hxdevelopmental care of the adolescent pregnant patientmonitor for iron deficient anemia STI screen preeclampsia risk higher high risk behaviors knowledge regarding personal care, care of infant, patient carenursing role in teen pregnancyheighten public awareness empower women/families to reduce unwanted pregnancies sexual education, advocate for responsible sexual behavior intersection of adolescent developmental tasks with tasks of pregnancy may not seek prenatal care may not be future oriented or accept reality of the unborn child *don't make negative assumptions however*leopold's maneuvershave mom empty bladder position her comfortably on back palpate with palms of hands identifying fetal parts 4 maneuversFirst maneuverfeelings hands at top of uterus or fundus, feeling for soft round object, feeling for the bottom determine breech or vertexsecond maneuverpalpate side of uterus soft/curved: back lumpier part: fetal partsthird maneuverfeel for headfourth maneuverchallenging, feel deep in the pelvis, feeling for fetal engagement place fetal monitor on back of baby or base of headlab work done at first visitblood type, RH factor antibody screen RPR or VDRL - test for syphilis rubella status: if non-immunized can be given postpartum, teratogenic so can not be given during pregnancy, contraception for one month after vaccination to avoid pregnancy Hep B status HIV CBCnormal pregnancy lab valuesHgB > 11 (10.5) Hct >33 RBC 5-6.25 WBC 5000-15000 Ptt dec slightly PT dec slightly Platelets no sig change until 3-5 days after birth, then rapid increase Bilirubin <= 1.0 Serum Cr decreases blood glucose 60-90 before food, 60- 105 before lunch, dinner and snack Urine glucose present in 20 % of pregnant women ESR elevated in 2nd and 3rd trimesterImportant dietary nutrients and sources to obtain them from- educationprenatal vitamins iron- 30 mg daily, vitamin C help folic acid 600 mcg per day 2nd and 3rd trimester 300-400 calorie increase high protein intake is importantfoods to avoidexcessive coffee alcohol cigarette fish with high mercury levelsfactors that affect nutritionhyperemesis eating disorders (PICA, Anorexia, bulimia) cultural factors veg diets food cravings/aversionsexerciseno rigorous activity you weren't cleared for or didn't participate in before pregnancy no contact sportsS/S of ovulationspinnbarkheit: elastic, clear cervical mucus ferning: crystallization of CM inc basal body temp mittelschmerz: abdominal cramping during ovulationdominant, recessive*Gene Traits* are represented in *pairs* with an *upper case letter* for the dominant trait *(A)* and a *lower case letter* for the recessive trait *(a)*. Occur in pairs *(AA, Aa, aa)*. Half the genetic material is from each parent, Offspring's traits are represented in combinations. -*Dominant*: Trait only requires *one gene* of a gene pair for it to be expressed in a *phenotype*. -*Recessive*: Requires both genes in order to be manifested. *DD and dd* are *Homozygous Pairs* *Dd* is a *Heterozygous Pair*autosomal recessivesickle cell anemia cystic fibrosisautosomal dominantmarfans huntington's disease neurofibromatosis myotonic dystrophy (MD) stickler syndrome dwarfism treacher collins syndromeX-linked dominant inheritancevitamin D resistant rickets Rett syndromex linked recessive inheritancehemophilia color blindness duchenne muscular dystrophymaternal age and chromosomes35 + higher risk down syndrome risk inc deletion translocationmultifetal pregnancypregnancy in which more than one fetus is in the uterus at the same time; multiple gestationmonozygoticidentical twins develop from one zygoteDizygoticfraternal twins develop from two zygotesteratogensagents, such as chemicals and viruses or other toxic drugs, that can reach the embryo or fetus during prenatal development and cause harmcommon substances that are teratogenicsmoking (low birth weight, SIDS) alcohol (FAS, brain damage, withdrawal) Cat X drugs Some herbal and homeopathic preparations not recommendedherbal supplement patient educationalways ask HCP before using a substance or herbal supplement that was not prescribed to check the safety for mom & babyFDA drug categoriesA: safe B: no fetal risk in animals, fetal risk in humans not identified C: evidence of adverse effects in animals, human fetal risk unidentified D: evidence of adverse effects and fetal risk; benefit must outweigh risk before prescribing X: fetal risk, risk always outweighs benefitsplacentadevelops from trophoblast cells; forms at implantation lacunae, chorlonic villi: nutrition, blood oxygenation, nutrition, waste elimination, hormones, protection growth and enlargement through 20 weeks, thickens after 1-1.5 lbs at birth best if attached to posterior wall grows with babyamniotic fluidfetal urine and lung secretions slightly alkaline contains antibacterial and protective substances purpose: protect, thermoregulation, fetal movement, essential for lung development, 700-1000 ml volumeumbilical cordcenter of placenta 1 vein, 2 arteries wharton's jellyyolk sacdevelops 8-9 days after conception essential for nutrient transfer 2-3 weeks gestation hematopoeisis atrophies and incorporated into umbilical cordTORCH infectionstoxoplasmosis other infections rubella cytomegalovirus herpes simplex virusuterushouses the fetus and placenta, grows with babyovariesproduces eggsfallopian tubestransports eggs from ovaries to uterusbiophysical profile (BPP)uses a real-time ultrasound for visualization of physical and physiological characteristics of a fetusalpha fetoprotein (AFP)A blood test that measures the level of alpha-fetoprotein in the mothers' blood during pregnancy as an indicator of possible birth defects in a fetusmultifactorial inheritanceseveral genes; an interaction between genes and the environment that contributes to a phenotype or traitunifactorialOne gene consisting of a single pair of alleles, one dominant and one recessiveduvall stages of family developmentprepare for role as childcare providers reorganize home, family member duties, patterns of finances reorient family relationships each pregnancy: adjust to transitions in relation with other childrenRubin: "tasks of pregnancy"Incorporate pregnancy into identity Acceptance of the child Reorder relationshipsCouvadefather experiences symptoms of pregnancyconsiderations for older gravida patientsidentify chronic medical problems identify lifestyle habits physical exam: breast and circulatory problem focused assessment offer screening for chromosomal abnormalities