Pregnancy 2

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Nutrition: Daily Requirements
Weight Gain
Eating Disorders- PICA(food substitutes, not food)
OTC Meds
Smoking- Growth Retardation
Folic Acid- Before Pregnancy need to take 400mg folic acid to prevent spinabifida.
Iron Deficency Anemia
Inaddicuate Nutrition: Fetal Deprevation
Preterm Birth
Still Borns
Congenital birth deficts
Preg Moms- 300 calories per day, Vitamin B-12, Protein 3 servings a day, Carbs 6 servings a day, Dairy 4 servings a day for bone formation, Fruits 2 servings a da, Vegies 3 servings a day.
Weight Gain: Avg preg weight gain is 25-35 lb with normal preg.
1st 20 wks- woman gain 10-15 lbs
After 20wks gain 1 lb per week.
Where weight comes from.: Fetus, Plecenta, and emlionic fluid give you 20 lbs.
Increase in BV about 4 lbs.
Breast Tissue 3 lbs.
Maternal Stores - 5-10 lbs.
Over the counter medication: Affect fertilized ovum embriyo or fetus.
Smoking: Low birth weight infants, growth retardation. Snijubg vasicibstructuib ti yterube muscle limit supply to fetus.
Caffine: No caffine stimulates system. Low birth weight baby.
Alcohol: No alcohol, cognitive impairment, cognitive deformities.
Folic Acid: Formation of RBC. Take folic Acid decrease neurotube diffects. Prenatal vitamins have iron supplements.
Estrogen: stimulates uterine development to provide enviornment for fetal growth. Prepare breast for lactation.
Human Choronic Gonadtropin (HCG): Stimulates progesterone/estrogen production to maintain the pregnancy. Urine Test 2 days after missed period.
Human placental Lactogen (HPL): Promotes lipolysis. Insulin antagonist release of nsulin. Inhibits higher free fatty acids avaliable for maternal metabolic use. Lower maternal metabolism of glucose to allow fetal growth.
Progesterone: Maintains the endometrium and inhibits uterine contractions. Prevent abortions. Aids in prep for lactation.
Prostaglandin: Assosiated with the onset of labor. Lipids found throuout repoduction system. High concentration found in preg. Pregnancy Induced Hypertension.
Relaxin: Inhibits uterine contractions/softems cervix. Found in maternal serum from time of firse pissed period.
Cardiovascular system Physiologic anemia: (plasma volume increase 50%=7% decrease in hematocrit)
Vena Cava Syndrome: Decreased blood flow to right atrium lower blood pressure. Dizzy, clamy skin, pale. Left side, pillow under right hip.
Hypercoagulation: Blood vessel higher 45%. Red blood cells 18-30%. Cardio Output 30-40%. 10-15 BPM
Heart rate increases
Blood pressure changes.
Respiratory System: Nasopharyngeal Edema- Nasal stuffiness.
Shortness of breath.
Renal System: Glycosuria
Glomerular Filtration rate (GPR)- Kidneys not able to absorb all Gluose, GFR higher 50%.
Urinary Frequency
1st Trimester: Uterus presses on bladder= urinary frequency
2nd Trimester: Relieved by uterus moving into abdominal area. GFR higher 50% 2nd trimester till delivery.
3rd Trimester: Urinary frequency as the presenting part presses on the bladder.
Gastrointestinal System: Hyperptyalism- higher siliva formation.
Pyrosis/Heartburn
Decreased gastric motility- Constipation.
Nausea and Vomiting
Displacement of stomach.
Slowed intestinal parasaltisis.
Increase in prenatal levels smooth muscle and parastalsis evidence of feeling better.
Integumentary System: Increased pigmentation
Striae gravidarium
Linea Negra
Cholasma- Skin gets darkin on forehead around eyes.
High levels of estrogen make skin darker.
Strech Marks- High adrenal and steriod levels make connective tissue strech dark pigmented.
Musculoskeletal System: Lordosis- Curvature in spin compensates weight of baby.
Carpal Tunnel Syndrome
Diastasis recti
Endocrine System: Thyroid Gland
Parathyroid
Pancreas
Pituitary Gland
Thyroid Gland: Enlargement causes an increases in metabolic weight.
Parathyroid: slight enlargement bettr for calcium and vitamin D. Decrease in insulin production. Allows more glucose availability for fetal growth.
Pituitary Gland: Increase in secreation of prolactin, prepares breast for lactation.
Uterus: Increase in size palpable by end of 12th week.
Lightening
Hegar's Sign
Braxton Hicks Contractions
Lightening: Baby drops on pelvis.
Hegar's Sign: Evident 6-8 weeks softening of the lower uterine segment.
Braxton Hicks Contraction: False Labor
Cervix: Goodell's Sign
Mucus Plug
Goodell's Sign: 8 weeks softening of cervix
Mucus Plug: Barrier, baby can not have a BM.
Vagina: Chadwick's Sign
Increase in vaginal discharge
Chadwick's Sign: Cervix and vaginal wall (blue/purple). Acidic white and thick, breast changes estrogen and progesteron.
Breast Changes: Fullness/tingling/tenderness/darkened/areola/prominent blue veins/secretion of colostrum by 16th week.
First Trimester (1-12 weeks): Acceptance
Announcement
Ambivalence
Second Trimester (13-24 weeks): Differentiation
Fetal Embodiment
Visulization
Quickening- Visualisation by ultrasound 12 weeks, feel baby more 16-20th week.
Third Trimester (25-40 weeks): Separation of baby
Concerned with safe delivery
Childbirth education
Nesting
Covade- get same thing mome does
Preparing for parenthood.
Signs of Pregnancy Presumptive (subjective): Finding reported by the mother that suggest presence of pregnancy. Amenoria, missing period. Brease changes, nausea vomiting, quickening.
Signs of Pregnancy Probable (obj): Finding noted by a healthcare provider that suggest a pregnancy is present. Hager, Chedricks, Enlarged abdomin. Pigmentation and pregnant test. Palpation of fetal outline.
Signs of Pregnancy Positive (diagnostic): Finding that confirm pregnancy. Fetal heart tones, 120-160 BPM. Doppler heart sound, baby 20-24 weeks and fetal movement 12 weeks. Visulization of fetus. Brain and heart beat visulaize by 8 weeks.
First Trimester Discomforts: Nausea/Vomiting
Fatigue
Urinary Frequency
Breast Tenderness
Salvation
Second/third trimester discomforts: Heartburn
Ankle edema
Varicose Veins
Hemorrhoids
Constipation
Backache
Leg Cramps
SOB
Difficulty Sleeping
Warning Signs of Pregnancy: Bleeding
Decreased Fetal Movements
Headache
Edema of hands of face
Visual changes
Pain
Symptoms of infection
Prenatal Screening: Gestational Age
-Nagele's Rule
Obstertrical History
-Gravida (# of times pregnant)
-Parity (# infants delievered >20wks.)
-FPAL
Medical History/Past Medical History
-Surgeries
-Chromosomal abnormalities
Prenatal Screening cont.: BP/weight, fundal height.
1cm=1week
Symphatic pelvis to above uterus 10-12 weeks heart tones.
Any signs of edema.
Urine dipstick, glucose, protein, edema.
Every 4 till 28 weeks.
Every 2 weeks till 36
Every week till Delivery.
Nagele's Rule: First day of last mentral period, go back 3 months and add 7 days.
Laboratory Screening: Initial Labs
H&H/WBC
Blood Type and Cross/RH (RH-, recieve rogam at 28 weeks)
Ryubella
DRL (Syphalis)
GC (Gonorea Chlamidia)
HBsAg (antibody titer for Rub/hep B)
MSAFP(16-18weeks)
Diabetes Screen (24-28 weeks)
HIV (AZT)
Genetic Screening
Gravida Parity: G/P- Gravida/Parity FPAL
F- Full Term Birth (37 weeks higher)
P- Premies (Lower then 37 weeks, 20-36 weeks)
A- Abortions (lower then 20 weeks)
L- Living
Gonorea: Neonatal sepsis
Preterm growth blindness.
IUGR- Intra uterine growth retardation.
Diabetes Screen (24-28 weeks): 50g oral
Draw Blood
Higher 140 needed
3 hrs CTT
Chlamidia: Phnemonia conguctivitis.
MSAFP- Maternal Serum Alfa Fetal Protein: Maternal Serum Alfa Fetal Protein.
Higher chance neural tube defict or abdominal defict. Lower suspect down syndrome. Will do eminio Centesis.
GYN History: Last pap smear/ normal. Sexually transmitted disease periods regular how long last dismineria, contraseption.
TOURCH Infections: Cross placenta
Toxoplasmosis
Other Infections
-HIV/Hepatitis/GBS/Syphillis/Varicella
Rubella
Cytomegalovirus
Herpes Simplex
Toxoplasmosis: Protozol infection eating improperly cookd meats or fetal or contact to cat feces or liter.
Other Infections: HIV/Hepatitis/GBS/Syphillis/Varicella
Fetal Brain damage and abort in first trimester.
GBS- Group B streptococcus cause preterm labor, UTI, (PROM) Premature rupture of the membrane.
Rubella: Fetal infection abort. Hearing impairment psychomotor retardation. IUGR congenital Heart Disease.
Cytomegalovirus: Mental Retardation and audatory.
Herpes Simplex: IUGR- Intrauterine growth reduction.
Diagnostic Tests: Ultrasound
CVS(Chronic Villus Sampling)
Amniocentesis
MSAFP (Maternal Serum Alpha Fetal)
PUBS (Percutaneous Umbilical Blood Sampling)
BPP (Biophysical Profile)
NST (Non Stress Test)
CST (Contraction Stress Test)
Ultrasound: As early as 5 weeks
CVS Chronic Villus Sampling: High risk determineee fetal caratype, sickle cell anemia
Amniocentesis: 14-16 weeks gestation >30 weeks gestation. If suspect early pregnancy.
MSAFP Maternal Serum Alpha Fetal protein: 16-18 weeks gestation.
BPP Biophysical Profile: 3rd trimester. Fetal breathing movement, fetal movement, fetal tone extension and flex ion, Emnonic Fluid Volume.
NST Non stress test: Fetal heart rate with fetal movement done x2 in 20 min intravals. 2 or more of 15 beats per min for 15 sec intervals.
CST Contraction Stress Test: Provoke contractions in hospital. Fetal abiility to withstand uterine contractions
Watch fetal heartrate when contraction. Lower heart rate could not be getting O2
PKU: Down Syndrome, Peuchne muscular dystrophy.

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