1st Trimester Flashcards
1st Trimester
0-12 weeks
Presumptive signs of pregnancy
- Amenorrhea
- N/V (“morning sickenss”) (most common)
- Unexplained fatigue
- Skin changes
- Sensation of movement in abdomen 16-20wks(quickening)
- Frequent urination (enlarged uterus, increased circulating volume)
- Breast tenderness and changes
- Ptyalism (excess salivation
Probable signs of pregnancy
- pregnacy test (hCG, by blood or urine)
- Softening of cervix at 6-8 wks (Goodell’s sign)
- Bluish coloration of cervix, vagina, and vulva at 6-8 wks (Chadwick’s sign)
- Enlarged abdomen
- Braxton-Hicks
- Passive movement of fetus furing an exam (ballottement)
Hegar’s sign
Softening of lower uterine segment
Goodell’s sign
Softening of cervix at 6-8 wks
Chadwicks sign
Bluish coloration of cervix, vagina, and vulva at 6-8 wks
McDonald’s sign
Flexion of body uterus against cervix
Braxton Hicks
Irregular, painless uterine contractions that begin in the 2nd trimester
Ballottement
Fetal part is displaced by light tap of the examining finger on the cervix and then rebound quickly (occurs about 20-28 weeks)
hCG
hormone produced by the chorionic cvilli of placenta
Used to test for pregnancy
Radioimmunoassay (RIA)
Type of pregnancy test
Reliable at 1 wk after ovulation
Positive signs
- Fetal heart sounds heard by doptone or doppler
- Fetus visible on ultrasound or visualization
- Fetal movements felt by caregiver
When can a fetal outline be identified?
After the 24th week
Abdominal striae
- Stretch marks
- Breakdown and atrophy of underlying connective tissue
What is abdominal striae due to?
The stretching and increased estrogen that causes a rise in adrenal gland activity
Fetal ultrasound
- Can be done by the 4th -5th wk of pregnancy if problems
- Noninvasive
- Routinely done at 8-12 wks
- Never done just to determine sex
Doppler of FHR
110-160 bpm for 2 mins
What are the components of an initial exam?
Medical History Dates Pelvic exam Blood test Testing for fetal abnormalities Counseling
Medical history during an initial exam
Medical conditions, including allergies
Menstrual cycle, use of contraceptives, past pregnancies, STDs
Prescription or OTC meds
Family history of congential abnormalities or genetic diseases
Sensitive issues, (abortion, past drug use)
Naegele’s rule for determining EDB
1st day of LMP minus 3 month plus 7 days and 1 year
EDB example using Naegele’s rule if LMP was 4/15/08
1/22/09
What does a pelvic exam inlcude?
Normal anatomy throughout External genitalia- lesions Vagina- infection, lesions Cervix- pap, can help to confirm pregnancy Ovaries- pain, enlargement Uterus- size
How many shapes are there for a bony pelvis?
4: Gynecoid Android Anthropoid Platypelloid
Blood tests during 1st trimester
Blood type, including Rh Syphilis MMR Hep B HIV Varicella Toxoplasmosis
Urine tests during 1st trimester
Urinalysis (glucose, protein, signs of infectoin)
Culture and sensitivity- bladder/kidney infection
Screening tests during 1st trimester
Chorionic villus sampling
Amnocentesis
Ultrasound
Blood tests- alpha fetoprotein
Fetal alpha protein
Protein made by immature liver cells
Spills into the amniotic fluid
May indicate neural tube defect
Why CVS (chorionic villus sampling) or amnio?
- Abnormal results from a prenatal screening test
- Chromosomal abnormality in a previous pregnancy
- Age 35+
- Family hx of a specific genetic disorder, patient or partner is a known carrier of a genetic disorder
- IDs Down syndrom and other disorders (tay-sachs, CF)
- Neural tube defect (amnio only)
- Lung maturity (late amnio)
CVS/Amnio risks
- Miscarriage (CVS has 1/100 risk)
- Cramping & Vag bleeding
- Rh sensitization (CVS may cause baby’s blood cells to enter maternal bloodstream; if Rh-, give Rh immunoglobulin (rhogam) after test)
- Infection
- Needle stick, leaking fluid (amnio)
Counseling for 1st trimester: Lifestyle issues
Nutrition Prenatal vitamins Exercise Work environment Tobacco use Substance use (ETOH, drugs, meds) Personal issues
Counseling for 1st trimester: Body changes
Tender breasts Bouts of N/V Unusual fatigue Increased urination Dizziness
Physiology of changes in pregnancy
Increase in candida albicans Mom breathes more deeply Nasal stuffiness Changes in voice Epistaxis Mom's HR increases 10-15 bpm Increase incidence in DVTs Ptyalism Pyrosis Pruritus Waddling gait
Sycope during pregancy
Blood volume increaes
Vascular changes (dilation) allow for the extra blood
Pooling in the vascular system
