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OB Kaplan
Fichas del conjunto (43)
- 1DyspareuniaPain with Intercourse
- 2Naegele's RuleCount back 3 mo from 1st day of LMP & add 7 days (& possibly 1 yr)
(- 3mo + 7 days) - 3Fundal HeightFrom top of symphysis pubis to top of fundus w/ tape measure for a gross estimate of dates.
Above symphysis pubis: 12-14 wk
@ umbilicus (20 cm) @ 20 wk
Rises 1 cm/week until 36 wk - 4Gravida NulligravidaTotal # of pregnancies regardless of duration (including present one)
Nulligravida: Woman who has never been pregnant - 5Para Primipara# of past pregnancies beyond period of viability (fetus able to survive outside uterus-after 20 wk) regardless of # of fetuses
# of infants (born dead or alive) delivered after 20 wk - 6TermBeginning of 38 to end of 42 weeks
- 7AbortionAny pregnancy that terminates bf the period of viability
- 8Cervix Characteristic FindingsSoftens, mucus plug in canal, bluish color (Chadwick's sign)
- 9Chadwick's SignBluish color of cervix
- 10Blood Volume During PregnancyIncreases 30%
[significant growth in blood volume during pregnancy] - 11Skin during Pregnancy (Striae gravidarum, chloasma, linea nigra)Striae Gravidarum: Pink, reddish streaks on breasts, abdomen, buttocks, and/or thighs (fat deposits cause skin to stretch)
Chloasma: Mask of pregnancy - increased pigmentation on face with blotchy brown areas
linea nigra: Dark line from umbilicus to symphysis pubis - 12Urinary Findings During PregnancyFrequency & stasis from pressure
- 13Hormones Produced by the Placenta during PregnancyEstrogen, progesterone, human chorionic gonadotropin (hCG)
- 14Weight Gain During PregnancySteady, consistent
Total: 24-28 lb - 15hCGBlood or urine
Serum more sensitive - results more accurate and available earlier - 16presumptive signs of pregnancychanges felt by woman:
amenorrhea, n/v "morning sickness", breast sensitivity, fatigue, quickening(maternal perception of fetal movement b/t 16-20 wk), urinary frequency - 17probable signs of pregnancyChanges observed by examiner: uterine enlargement, positive urine pregnancy test, Hegar's (softening & compressibility of isthmus of uterus), Chadwick's sign (bluish color of cervix)
- 18Positive Signs of PregnancyDEFINITE signs of pregnancy:
Fetal heartbeat (by doptone or auscultation), palpation of movement, visualization of fetus by US - 19In 1 hr, when to report low fetal movement (FM)Fewer than 3 movements in 1-hour period
- 20Fertilization (what, when, where)What: Union of ovum and spermatozoa (sing: spermatozoon)
When: About 24 hr after ovulation
Where: Fallopian Tube - 21Implantation (where, when)Where: Upper part of uterus
When: 1 wk after fertilization - 22Early Placental DevelopmentCombo of endometrium & fetal chorionic layer (maternal & embryonic parts)
Chorion produces hCG - 23Discomforts of PregnancyN/V (morning sickness)
Constipation, hemorrhoids (decreased peristalsis)
Heartburn: Small frequent meals, antacids, avoid supine post meals
& others - 24Sickle Cell Disease (Anemia)African Americans
- 25Tay-Sach's DiseaseNorthern European descendents of Ashkenazi Jews; Autosomal recessive trait
Apathy, regression in motor & social development, decreased vision {Enzymes remove fatty protein that interferes w/ growth. Born without one, hexosaminidase A (HEXA). Fatty proteins build up in brain, hurting sight, hearing, movement, mental development - 26Types of Chromosomal Alterations with Examples1. Numeric
2. Structural
Ex: Down Syndrome, Turner's Syndrome, Klinefelter's syndrome - 27Autosomal Defects with ExamplesDefects occurring in any chromosome pair other than sex chromosomes
Ex: CF, sickle cell disease, hemophilia, BRCA-1, BRCA-2 breast cancer - 28Inborn errors of Metabolism - Genetic Considerations for Fetal Development with ExamplesDisorders of protein, fat, or carbohydrate metabolism d/t absent or defective enzymes that generally follow a recessive pattern of inheritance
Ex: PKU, Tay-Sach's disease, CF - 29Down Syndrome (Trisomy 21)Increased in women over 35
small, round head with flattened occiput, low-set ears, short neck, protruding tongue, small mouth, slanted eyes, hypotonic muscles, transverse simian palmar crease (single crease), mental deficiencies - 30Turner's SyndromeFemale with only one X
Stunted growth, fibrous streaks in ovaries (usually infertile) - 31Klinefelter's SyndromeMale with Extra X
Usually infertile - 32Autosomal dominant and ExamplesUnion of normal and affected parent genes - 50% of passing on abnormal gene in each pregnancy
Ex: BRCA-1 & BRCA-2 breast cancer - 33Autosomal Recessive and ExamplesRequires transmission of abnormal gene from BOTH parents for expression of condition
Ex: CF, Sickle cell disease - 34Sex-linked Transmission traits and ExamplesTrait carried on a sex chromosome (usu X chromosome); may be dominant or recessive, but recessive more prevalent
Ex: Hemophilia, color blindness - 35Phenylketonuria (PKU)Disorder d/t autosomal recessive gene creating deficiency in liver enzyme phenylalanine hydroxylase, which metabolizes the AA phenylalanine; results in metabolites accumulating in blood --> toxic to brain cells
- 36Cystic Fibrosis(Mucoviscidosis or fibrocystic disease of the pancreas)
Autosomal recessive trait characterized by generalized involvement of exocrine glands, resulting in altered viscosity [thick] of mucus-secreting glands throughout the body [GI, Respiratory, sweat] (lungs fill with mucus --> lots of infections) (block secretions from pancreas from entering small bowel --> can't absorb, severe constipation) - 37Alpha-Fetoprotein Test (AFP)Fetal serum protein to predict neural tube defects, threatened abortion, fetal distress; decreased AFP levels suggest possible Down syndrome
B/t 16-18 wk
High incidence of false-positive - 38Chorionic Villus Sampling (CVS)Early test to diagnose fetal karyotype, sickle-cell anemia, PKU, Down, Duchenne muscular dystrophy (genetic abnormalities)
8-12 wk (class: 10-13)
Abdominally or transvaginally
US guide
Get sample of fetal placental tissue for genetic make-up
Risks: Bleeding, spon. abortion, ROM
RhoGAM after test to prevent isoimmunization - 39AmniocentesisNeedle inserted thru abdominal and uterine walls
Aspirated amniotic fluid contains fetal cells
14-18 wk: Genetic disorders
Late in pregnancy: Assess L/S ratio to determine lung maturity
Risks: Premature labor, infection, Rh isoimmunization, abruptio placentae, amniotic embolism
RhoGAM after procedure for Rh+ - 40Ultrasound (US)Drink fluid prior to test to have full bladder & assist in clarity of image
- 41Non-stress Test (NST)US transducer records fetal movements
Doppler US measures FHR
Assess fetal wellbeing after 28 wk
Reactive: 2 or more accelerations of 15 bpm lasting 15 sec in a 20-min interval & return of FHR to baseline - 42Contraction Stress Test (CST) or Oxytocin Challenge Test (OCT)Nipple stimulation or exogenous oxytocin stimulation - eval fetal response to stress of labor
Positive: Late decels ... (may need c/s)
Negative: No late decels...
Monitor for post-test labor onset - 43TORCH Test SeriesGroup of maternal systemic infection that can be transmitted across placenta or by ascending inf. (after ROM); cause congenital issues
T: Toxoplasmosis (protozoa) - discourage undercooked meat & handling cat litter
O: Other
Gonorrhea/syphilis
Varicella/Shingles
Group B Beta (Group B Strep infx): During L&D; treated with penicillin
Hep B (HBV) -esp.- given Mom immune globulin w/ exposure or begin 3 vaccine series
Hep A (HAV): Avoid contaminated food & water; self-limiting, use proper handwashing (fecal-oral route)
HIV/AIDS
R: Rubella (German measles): Rash; vaccine not given during pregnancy
C: Cytomegalovirus (CMV)
H: Herpes Simplex Virus (HSV): Transmitted during birth via ascending if active lesions (c/s with active lesions)
Need to undergo testing for titers & risk of infx
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- Fichas sobre OB Kaplan, creado por karen.rans el 23/04/2015.
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- karen.rans
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