12. Prenatal Flashcards
Three categories of pregnancy signs
Presumptive
Probable
Positive
Define “Presumptive” signs of pregnancy
Subjective changes felt by the woman – not diagnostic (least reliable)
Define “Probable” signs of pregnancy
Signs, symptoms and/or changes that can be observed by an examiner. – Not diagnostic (but more reliable)
Define “Positive” signs of pregnancy
Signs that cannot be attributed to anything but pregnancy– Diagnostic.
Presumptive signs and symptoms (6)
- Amenorrhea
- Fatigue
- Nausea and vomiting
- Breast changes
- Urinary Frequency
- Quickening
Breast changes with pregnancy (Presumptive - 3)
o Tingling
o Heaviness
o Tenderness
Four characteristics of “Quickening”
o The feeling of fetal movement
o Often described as a “fluttering”
o Difficult to distinguish between fetal movements and peristalsis
o Occurs at 16-20 weeks
Probable Signs and Symptoms (8)
don’t memorize
- Pregnancy Tests
- Chadwick’s Sign
- Goodell’s Sign
- Hegar’s Sign
- Ballottment
- Enlarged abdomen (uterine)
- Braxton Hicks Contractions
- Pigment changes – vagina, cervix
Pregnancy Tests – Accuracy
o 95-98% accurate. It is possible (but not likely) to have a false positive
o After a terminated pregnancy, your hCG levels remain elevated for a short time. (False +)
Chadwick’s Sign
o Blue-purple discloration of the cervix
Goodell’s Sign
o Softening of the cervix
Hegar’s Sign (including when)
o Softening and compressibility of the lower uterine segment (isthmus) after 6 weeks gestation
Ballottment
o Palpate fetal body part and it “bounces back” to examiner’s hand when cervix is tapped (16-18 weeks)
Positive signs of pregnancy (3)
- FHT (Fetal Heart Tones)
- Visualization of fetus – Ultrasound
- Palpating fetal movements – Felt by the examiner
Serum Pregnancy Tests:
• Test for ______
• Type
• ___ days after conception
- Beta hCG
- Quantitative
- (+) by 6-11 days after conception
Urine Pregnancy Tests:
• Test for ______
• Type
• ___ days after conception
- hCG
- Qualitative
- (+) by 17-25 days after conception
Other possible causes of Amenorrhea (5)
- Emotional stress
- Strenuous physical exercise • • Endocrine problems
- Chronic disease
- Early menopause
Other possible causes of Nausea and Vomiting (3)
- GI virus
- Food poisoning
- Emotional stress
Other possible causes of Fatigue (3)
- Illness
- Stress
- Sudden changes in lifestyle
Other possible causes of Urinary Frequency
• UTIs
Other possible causes of Breast and Skin changes (2)
- Premenstrual changes
* Use of oral contraceptives
Other possible causes of Vaginal / Cervical Color changes (2)
- Infection
* Hormonal imbalance
Other possible causes of Quickening (3)
- Abdominal gas
- Peristalsis
- Pseudocyesis
Other possible causes of Abdominal enlargement
• Abdominal or uterine tumors
Other possible causes of Cervical Softening (2)
- Infection
* Hormonal imbalance
Other possible causes of Ballottment
• Uterine or cervical polyps
Other possible causes of Braxton Hicks contractions
• Leiomyomas
Other possible causes of Palpation of fetal outline
• Leiomyomas (large ones may feel like fetal head, small soft ones may feel like other parts of fetus
Other possible causes of positive pregnancy tests (4)
THINGS THAT PRODUCE hCG: • Certain medications • Premature menopause • Blood in urine • Malignant tumors
Other possible causes of auscultation of fetal heart sounds
None. This is a positive sign.
Other possible causes of Fetal movements.
None. This is a positive sign.
Other possible causes of visualization of embryo or fetus.
None. This is a positive sign.
Pseudocyesis (def)
False pregnancy
Leiomyomas (def)
Soft uterine fibroids
How to document gravidy and parity
Gravidy Parity • Term • Preterm • Abortions • Living
Gravidy (def)
Number of pregnancies, regardless of outcome
Parity (def) - when documenting G/P
Number of times a woman gives birth beyond 20 weeks
Term (def)- when documenting G/P
Number of births after 37 weeks
Preterm (def)- when documenting G/P
Number of births before 37 weeks
Abortions (def) - when documenting G/P
- Def
- Two types
Pregnancies ending before 20 weeks
• SAB = Spontaneous
• VTOP = Voluntary
Living (def) - when documenting G/P
Children currently living
Components of the physical exam on 1st prenatal visit (5)
- Blood pressure
- Height and weight
- Urine dip (glucose, protein)
- Head to toe exam
- Pelvic exam
Nägele’s Rule (def)
Used to determine “due date” based on a woman with a “normal” cycle of approximately 28 days
Other ways of saying “due date” (medical - 3)
- Estimated date of birth (EDB)
- Estimated date of delivery (EDD)
- Estimated date of confinement (EDC)
How to calculate EDD using Nägele’s Rule
- First day of LMP
- 7 days
- 3 months
- SUBTRACT A YEAR
Frequency of prenatal visits (three breakdowns)
- Before 28 weeks: Q 4 weeks
- 28 – 36 weeks: Q 2 weeks
- Week 36- Birth: Q 1 week
- Can be more frequent if there are complications, questions or concerns
What is included in prenatal follow-up visits (7 things - don’t memorize)
- BP, Height and weight
- Urine dip stick
- Abdominal exam
- Patient ed: Danger sxs to report to provider immediately
- Patient ed: Sxs of pre-term labor
- Complaints
- 3rd trimester: Discuss preparation and readiness for birth
What is included in a prenatal abdominal exam? (4)
- Fundal height
- Fetal heart tone
- Leopold’s Maneuvers
- Fetal movement
10 sxs to report to provider immediately during pregnancy
don’t memorize necessarily
- Vaginal bleeding
- Alteration in fetal movements
- Rupture of membranes
- Visual disturbances
- Swelling of face or hands
- Severe headache
- Epigastric pain
- Fever or chills
- Contractions that increase in frequency or duration prior to 37 weeks
- Persistant vomiting
Four steps to Leopold’s Maneuver
1) Determine what fetal part is in the fundus
2) Determine location of small parts (feet, hands)
3) Determine what fetal part is presenting
4) Is there engagement?
