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OB Exam 2 Chapters/Modules

OB Study Guide

Exam 2: Chapters 6,7,8,9,10,11, Everyone: For final exam studying please highlight everything that was on the unit exam in this color. Thanks! Unit 3: Pregnancy and Fetal Development ○ Chapter 6 (Module 6): Module- Fetal Lifespan

• Chapter 6: Genetics, Conception and Fetal Development ○ Chapter 7,8 & 9 (Module 7): Module- Uncomplicated/Healthy Pregnancy
• Chapter 7: Anatomy and Physiology of Pregnancy
• Chapter 8: Nursing care of the Family During Pregnancy
• Chapter 9: Maternal and Fetal Nutrition ○ Chapter 10,1 1 & 12 (Module 8): Module- High-Risk Pregnancy - Chapter 10: Assessment of High-Risk Pregnancy - Chapter 1 1: High-Risk Perinatal Care: Preexisting Condition - Chapter 12: High-Risk Perinatal Care: Gestational Conditions ○ Chapter (Module 9): Module- Complications of Pregnancy- Hemorrhagic Disorders ○ Chapter 11 & 12 (Module 10): Module- Complications of Pregnancy- Hypertensive Disorders - Chapter 1 1: High-Risk Perinatal Care: Preexisting Condition - Chapter 12: High-Risk Perinatal Care: Gestational Conditions

Embryonic Stage (Weeks 3 – 8 )

The most critical stage because of organogenesis. Major organs and external structures begin to form, making this the most vulnerable period for teratogens. ● Week 3–4: Neural tube closes; heart begins forming. ● Week 5–6: Heartbeat detectable on ultrasound; liver begins RBC production. ● Week 6–7: Brain waves present. ● Week 8: All essential organs present in basic form; the embryo looks human.

Fetal Stage (Week 9 → Birth)

At week 9, the developing baby is called a fetus. Growth and maturation are the main focus, with refinement of all systems. ● Week 9–12: External genitalia differentiate; kidneys make urine; intestines return to abdomen. ● Week 13–16: Lanugo begins; skeletal ossification; early quickening may be felt. ● Week 17–20: Vernix covers skin, lanugo present, brown fat deposits begin. ● Week 21–24: Surfactant begins; fetus considered age of viability (~24 weeks). ● Week 25–28: Eyelids open, brain develops rapidly, sleep–wake cycles. ● Week 29–32: Nails present, subcutaneous fat increases. ● Week 33–40: Lanugo disappears, lungs mature, weight gain accelerates.

Musculoskeletal Development

The skeletal and muscular systems provide movement and strength for fetal growth. ● Week 5: Limb buds visible.

● Week 10–12: Cartilage replaced by bone (ossification begins). ● Week 16–20: Quickening (first felt movement by mother). ● Week 28+: Fat deposits increase, muscle tone improves.

Cardiovascular Development

The cardiovascular system is one of the first to function. ● Day 22–23: Heart tube begins beating. ● Week 6–7: Cardiac activity visible on ultrasound. ● Week 12: Fetal heartbeat audible with Doppler. ● Term HR: 1 10–160 bpm.

Respiratory Development

The lungs are immature until late pregnancy, but preparation begins early. ● Week 4–5: Trachea and lung buds form. ● Week 9: Fetal breathing movements begin. ● Week 24: Surfactant production begins. ● Week 35–36: Surfactant at mature levels for gas exchange.

Gastrointestinal Development

The GI system develops early, with the liver, intestines, and meconium formation. ● Week 6: Liver forms and produces RBCs. ● Week 6–10: Intestines herniate into cord, return by week 10.

● Allows for fetal movement and growth. ● Prevents cord compression. ● Normal volume: 700–1000 mL at term.

Placenta

Temporary organ essential for fetal survival. ● Fully functional by week 12. ● Functions: Gas exchange, nutrients, waste removal. ● Produces hormones: hCG, progesterone, estrogen, hPL, relaxin. ● Maternal and fetal blood never mix directly.

Umbilical Cord

Lifeline between fetus and placenta. ● 1 vein (oxygenated blood to fetus). ● 2 arteries (deoxygenated blood to placenta). ● Protected by Wharton’s jelly. ● Average length: 50–60 cm.

Fetal Movement

Fetal movement reflects health and neurological development. ● Quickening = 16–20 weeks. ● Consistent movement = well-being.

● Decreased/absent movement after quickening = possible hypoxia → prompt evaluation. ●

Kick Counts (Fetal Movement Counting)

Kick counts are a method to monitor fetal well-being in the third trimester. A healthy fetus should have regular, consistent movement; decreased movement can indicate hypoxia, growth restriction, or compromise. Guidelines ● Begin monitoring at ~28 weeks. ● Count in a quiet setting, lying on the side after meals. ● 2 methods commonly used: ○ Count until 10 movements are felt (should be within 2 hours). ○ Or: At least 3 movements per hour during active times. Patient Education ● Best done after eating or in the evening when the fetus is more active. ● Lie down, place your hand on the abdomen, focus on movements. ● Report immediately if: ○ <10 movements in 2 hours. ○ Noticeable decrease in movement compared to usual. ○ No movement after meals or stimulation

Abortion (Pregnancy Loss < 20 Weeks)

Abortion is the termination of pregnancy before viability (20 weeks). It may be spontaneous (miscarriage) or induced. Most spontaneous abortions are related to chromosomal abnormalities or maternal health issues.

● Provide emotional support and grief resources. ● Prepare for possible D&C or medications (misoprostol) to expel tissue. ● Administer Rhogam if mother is Rh-negative. ● Educate on rest, pelvic rest (no sex, no tampons), and when to seek care. Treatment ● Threatened: Bed rest, monitor, emotional support. ● Incomplete/Missed: D&C, misoprostol, IV fluids, antibiotics if infection. ● Complete: Supportive care, monitor for further bleeding.

Spontaneous Abortion (Pregnancy Loss < 20 Weeks)

Defined as pregnancy loss before 20 weeks, most often caused by chromosomal abnormalities. Can be classified into several types based on clinical presentation. Types of Abortion ● Threatened: Vaginal bleeding, cramping, cervix closed, fetus still viable. ● Inevitable: Bleeding increases, cervix dilates, membranes may rupture. ● Incomplete: Some products of conception expelled, tissue remains inside the uterus. ● Complete: All products expelled, uterus contracts, bleeding stops. ● Missed: Fetus dies in utero but is not expelled, may cause infection or DIC. ● Recurrent (habitual): ≥3 consecutive spontaneous abortions. Assessment/Labs

● Ultrasound: Confirms presence/absence of fetal heartbeat and retained tissue. ● hCG levels: Normally rise; falling levels indicate pregnancy loss. ● CBC: Check for anemia or blood loss. ● Blood type & Rh: Administer Rhogam if Rh-negative. Nursing Interventions ● Monitor bleeding, vital signs, and pain. ● Emotional support and referral to grief resources. ● Prepare for procedures: D&C (dilation & curettage) or meds (e.g., misoprostol). ● Bed rest, pelvic rest (no intercourse, no tampons). ● Education on when to seek care (heavy bleeding, fever, severe pain). Treatment ● Threatened: Observation, bed rest, hydration. ● Inevitable/Incomplete/Missed: D&C, suction curettage, or medication. ● Complete: No further intervention except follow-up.

Ectopic Pregnancy

Implantation of a fertilized ovum outside the uterine cavity, most commonly in the fallopian tube. A medical emergency if ruptured. Risk Factors ● PID or history of STIs. ● Endometriosis, tubal surgery.

● Complete Mole: No fetus, empty egg fertilized by sperm. hCG is extremely high. ● Partial Mole: Some fetal tissue present, abnormal chromosomes. Signs/Symptoms ● Brown, prune juice–like vaginal bleeding. ● Fundal height larger than dates. ● Severe nausea/vomiting (excess hCG). ● Preeclampsia before 24 weeks. ● No fetal heartbeat/movement. Diagnostics ● Ultrasound: “Snowstorm” appearance, no viable fetus. ● Very high hCG levels. Treatment/Nursing Care ● Evacuation of uterus via suction curettage/D&C. ● No pregnancy for 1 year → monitor hCG levels weekly until normal, then monthly. ● Rhogam if Rh-negative. ● Emotional support, grief counseling.

Placenta Previa

Placenta implants in the lower uterus, covering part or all of the cervical os. Types

● Complete: Placenta covers the cervix entirely. ● Partial: Placenta partially covers the cervix. ● Marginal: Edge of placenta at cervical os. Signs/Symptoms ● Painless, bright red vaginal bleeding in the 2nd or 3rd trimester. ● Soft, relaxed uterus. ● Normal fetal heart rate unless bleeding is severe. Diagnostics ● Ultrasound confirms diagnosis. ● No vaginal exams (risk of hemorrhage). Nursing Interventions/Treatment ● Monitor bleeding and fetal status. ● Bed rest, pelvic rest. ● IV fluids, blood products if hemorrhage. ● C-section delivery if complete previa

Placental Abruption (Abruptio Placentae)

Premature separation of the placenta from the uterine wall. A medical emergency with high risk for maternal/fetal mortality. Risk Factors ● Hypertension, preeclampsia.

● Labs: CBC (anemia, infection), hCG (pregnancy status), Blood type & Rh (administer Rhogam if Rh-negative). ● Ultrasound: confirm viability or retained tissue. Nursing Interventions ● Stabilize first: manage bleeding, give IV fluids, prep for D&C or medications (misoprostol) if needed. ● Provide pain management and monitor for complications (infection, DIC). ● Offer emotional support: listen actively, validate grief, and respect cultural/religious rituals. ● Encourage the use of memory items (footprints, photos, memory boxes) if parents desire. ● Offer spiritual care: chaplain visit, baptism/special rituals if requested. ● Screen for postpartum depression and connect with counseling or support groups. Treatment ● Threatened loss: observe, pelvic rest, emotional reassurance. ● Incomplete/Missed: D&C, suction, or medications. ● Complete: Monitor recovery, follow-up care. ● Rhogam for Rh-negative mothers. Patient Education ● Explain what happened clearly and compassionately. ● Instruct on warning signs: heavy bleeding, fever, severe abdominal pain.

● Discuss when it is safe to attempt another pregnancy (varies, but often 3– months after loss). Chapter 7: Anatomy and Physiology of Pregnancy Anatomy and Physiology Changes in Pregnancy: Female Reproductive System Changes in Pregnancy ● Conception triggers rapid adaptations; amenorrhea is an early manifestation. ● Uterine hypertrophy and hyperplasia support fetal growth; estrogen contributes to spiral artery remodeling for deep placentation. ● Breasts: estrogen and progesterone drive ductal and lobuloalveolar growth; colostrum production may begin; tenderness and leaking can occur. Cardiovascular & Hematologic Adaptation ● Blood volume increases 30–50% by mid–third trimester leads to increase cardiac output and stroke volume and heart rate. ● Systemic vascular resistance decreases (estrogen effect) leads to slight BP decrease mid‑pregnancy; returns to baseline late pregnancy. ● Physiologic anemia of pregnancy (hemodilution); most clotting factors increase which leads to higher VTE risk. ● Venous stasis from gravid uterus results in lower‑extremity varicosities; usually painless and improve postpartum. Respiratory Adaptations ● Maternal/fetal oxygen demand increases results in mild increase in respiratory rate. ● Diaphragm elevation reduces lung volumes; hyperventilation can occur; ‘lightening’ near term eases breathing. Gastrointestinal Adaptations ● Uterine enlargement displaces stomach and intestines results in early satiety and reflux risk. ● Progesterone slows GI motility and lowers LES tone and leads to heartburn, nausea and vomiting, constipation. Genitourinary Adaptations ● Kidney size increase 30%; GFR increase 50% resulting in physiologic glycosuria and proteinuria (significant elevations need evaluation).

● T = Term, the number of births at 37 weeks or after ● P = Preterm births, the number of births born before 37 weeks ● A = Abortion, the number of medical, procedural and or spontaneous abortions, miscarriages ● L = Living, the number of living children Substance Use Counseling & Screening ● Tobacco use causes fetal growth restriction, preterm birth, miscarriage. ● Alcohol/illicit drugs cause teratogenic risks. Use therapeutic, nonjudgmental screening to guide education/referrals. STI Risk Assessment: The Five Ps ● Partners, Practices, Protection, Past STIs, Pregnancy intention. ● Partner Violence (IPV) Screening ● Screen privately with direct, nonjudgmental questions; assess safety; refer as needed. Physical Examination & Fetal Heart Rate ● Vitals, BMI; consider breast and pelvic exam. FHR expected: 1 10–160 bpm; if not heard by 12 weeks via Doppler/fetoscope, get ultrasound. Prenatal Panel (First Trimester) ● CBC; Blood type; Rh factor; Rubella immunity; HBsAg; HIV; Syphilis (RPR); Urinalysis and urine culture. ● If anemia take iron plus vitamin C. If HBsAg+, infant gets Hep B vaccine + HBIG within 12 hr of life. Rh Factor, Sensitization, and Rho(D) Immune Globulin ● Rh-negative clients: prophylactic Rhogam at 28 weeks and within 72 hr after birth if newborn is Rh+. Also, after bleeding, trauma, or invasive procedures. ● Adverse effects: local site reactions, low-grade fever; rare anaphylaxis/hemolysis. Delay live vaccines ~12 weeks after immune globulin; administer MMR postpartum if nonimmune. Diagnostics: Ultrasound & CVS ● Ultrasound: viability, dating, anomalies, multiples. Transvaginal early (no full bladder), transabdominal later (full bladder). ● CVS (10–13 weeks): sampling placental tissue for genetics; contraindicated with active vaginal infection (e.g., gonorrhea, herpes). Weight Gain & Nutrition

Weight Gain in Pregnancy ● BMI Expected Weight Gain ● Less than 18.5 kg/m2 - 28 to 40 lb ● 18.5 to 24.9 kg/m2 - 25 to 35 lb ● 25 to 29.9 kg/m2 - 15 to 25 lb ● Greater than 30 kg/m2 - 11 to 20 lb ● Prenatal vitamin daily: folic acid, iron, iodine, calcium, vitamins A; C; D; B6; and B12. Emphasize balanced diet and omega-3 sources. ● Avoid high-mercury fish; limit white tuna; avoid raw/undercooked foods, unpasteurized products, unheated deli meats, premade meat salads, meat spreads, raw sprouts. Sorting Practice: Safe vs Unsafe Foods ● Safe: pasteurized dairy, fully cooked meats/seafood, heated deli meats, cooked eggs, washed produce, low-mercury fish. ● Unsafe: bigeye tuna/king mackerel/shark/swordfish/tilefish/orange roughy; raw sushi/oysters; unpasteurized milk/juice; unpasteurized soft cheeses; raw sprouts; raw cookie dough. Managing Nausea/Vomiting and Heartburn ● N/V: small frequent meals; BRATT; ginger; hydration; seek care for dehydration/hyperemesis. Heartburn: small meals; avoid spicy/greasy; elevate HOB; avoid lying flat after meals; antacids per provider. Sorting Practice: Eat vs Avoid (N/V & Heartburn) ● Eat: crackers, bananas, rice, applesauce, toast, ginger tea/capsules, small frequent meals. ● Avoid: large meals; spicy/greasy foods; eating late; lying supine after meals. Mental Health, Exercise, Sleep ● Screen for anxiety/depression; consider counseling and nonpharmacologic supports; SSRIs per provider after risk–benefit discussion. ● Exercise: mild–moderate 3x/week for uncomplicated pregnancies (walking, swimming). ● Sleep: early—any comfortable position; later—avoid supine (supine hypotension). Prefer left lateral with pillows. Pets & Toxoplasmosis ● Avoid changing litter; if unavoidable, use gloves and wash hands. Wear gloves gardening; wash produce; keep cats indoors; avoid raw meat for cats; cover sandboxes; avoid strays. Travel & Vaccinations (First Trimester)