anatomy and physiology of pregnancy Flashcards
Parity?
number of pregnancies carried past 20 weeks – not number of fetuses born & regardless of alive or stillborn
Gravida?
a woman who has been pregnant
Primigravida?
a woman pregnant for the first time
Primipara?
a woman who has delivered one child past gestation of 20 weeks
multigravida?
a pregnant woman who has been pregnant before
multipara?
a woman who has carried two or more pregnancies to 20 weeks or more
Nulligravida
a woman who has never been and is not currently pregnant
Nullipara?
a woman who has not completed a pregnancy with a fetus or fetuses who have reached 20 weeks or more
Preterm?
pregnancy that has reached 20 weeks of gestation but before completion of 37 weeks of gestation (20- 26.6 wks)
Viability
capacity to live outside uterus; about 22 to 25 weeks gestation are on the threshold of viability
These very premature infants are vulnerable to brain injury
Name the term weeks
early term
full term
late term
post term
Early Term- 37 0/7wk- 38 6/7wks
Full Term- 39 0/7wks- 40 6/7wks
Late Term-41 0/7wks- 41 6/7wks
Post Term- 42 0/7wks and beyond Term: pregnancy from beginning of week 38 of gestation to end of week 42 of gestation
Two digits. define
G
P
G – gravida – number of pregnancy
P – para- over 20 weeks
what is
GTPAL stand for ?
5 digits GTPAL Gravidity (# pregnancies) Term (deliveries >37 wk) Preterm (deliveries >20wk but <37wk) Abortions (deliveries <20wks spontaneous or induced) Living children
Tell me about pregnancy tests
Human chorionic gonadotropin (hCG) is earliest biochemical marker of pregnancy
Pregnancy tests based on recognition of hCG or β subunit of hCG
Can be detected in serum or urine as early as 7 to 8 days after ovulation
Enzyme-linked immunosorbent assay (ELISA)
testing is most popular method of testing for pregnancy
ELISA technology is the basis for most over-the-counter home pregnancy tests
Medication use, hormone based tumors, or improper collection may cause inaccurate results
Presumptive signs of pregnancy
Least indicative of pregnancy Amenorrhea N/V Breast changes Quickening Skin changes Linea nigra Melasma Striae gravidarum
Probable signs of pregnancy?
More reliable & more diagnostic, but not true diagnosis Positive lab tests Chadwick’s sign Goodell’s sign Hegar’s sign Ballottement Fetal outline felt by examiner
Positive signs of pregnancy
Ultrasound of fetus
Fetal heart tones by Doppler or ultrasound
Fetal movement felt by examiner
Cervix characteristics when uterine growth in pregnancy occurs
it becomes vascular and edematous
define
goodells sign
chadwick sign
hegar sign
Goodell’s sign -Softening of cervix- throughout pregnancy to prepare for delivery
Chadwick sign- bluish hue of the cervix and vagina
Hegar Sign- Softening of the area between the cervix and body of the uterus
what secretes progesterone and estrogen during the first 12 weeks? and why
Corpus luteum
Maintains pregnancy until placenta formed & functioning
What happens to the vagina during the growth of the uterine during pregnancy?
Chadwick’s sign Vagina purplish (and cervix)Increased vascularity of vagina Increased acidity to resist bacteria Increased sensitivity increased vaginal discharge - leukorrhea
What happens to the breast during the growth of the uterine during pregnancy?
and what do you educate?
Increase in size, vascularity
Feelings of fullness & tenderness as early as 6 weeks
Colostrum as early as 16 weeks
*** Education- Supportive bra;
Discuss value of breastfeeding
early; Reinforce self breast exam
What happens to the respiratory system during the growth of the uterine during pregnancy?
and what do you educate?
Shortness of breath Diaphragm displaced upward Lungs expand horizontally Nasal congestion Elevated estrogen Capillary engorgement
** Education:
Warm compresses, humidifier, position changes
What happens to the cardiovascular system during the growth of the uterine during pregnancy in regards to just blood volume?
Blood volume increases 1500 ml
1000 ml plasma
450 ml RBCs
Blood volume 25-40% greater than nonpregnant levels
Physiologic anemia: apparent decrease in hemoglobin & hematocrit
RBC production increases 30-33%
What happens to the cardiovascular system during the growth of the uterine during pregnancy in regards to blood cells?
and what do you educate?
Hemoglobin- less than 11.5 g/Dl or hematocrit less than 30% is considered anemia
WBCs -increase to 5000-12000/cubic mm.
Cardiac output increases – 30 – 50%
Increased Pulse (14-20-wk)
Increased Cardiac output
Decreased Blood Pressure (slight)- 1st trimester- 32wks Back to baseline in 3rd trimester
Supine hypotension syndrome
Lying supine obstructs blood return from extremities, decreases cardiac output, hypotension
** Education- Tilt; change positions slowly
What happens to the renal system with urinary output?
what about specific gravity?
urine output increases
sg decreases
What renal test do you do in pregnancies?
Creatinine clearance best test of renal function
Done on 24-hour urine sample
*** Education: Empty bladder completely; limit fluid intake in evening; avoid caffeine
What happens to gastrointestinal system during pregnancy?
Nausea/vomiting: Causes HCG & progesterone increase Estrogen increase Glucose levels decrease Heartburn due to displacement of stomach by uterus - pyrosis Slowing of GI tract leads to constipation, flatulence, heartburnDecreased tone and motility GI- incr P4 Reflux; Heartburn (pyrosis) Hemorrhoids common Pica – cravings for non-food items such as clay, laundry starch, and ice Gallstones Cholestasis Ptyalism – excessive salivation
What do you want to educate in pregnancy in regards to gastrointestinal systems?
*** Education*** Small frequent meals; Separate liquids from solids Ginger; B6 Eat crackers before getting out of bed Avoid greasy, spicy foods or triggers Stool Softeners
What happens to the musculoskeletal system in pregnancy?
Pelvic ligaments soften Excessive mobility of joints Lordosis - pride of pregnancy Diastasis recti *** Education- Maternity Belts Posture & mobility
What happens to the integumentary system during pregnancy?
Chloasma - “mask of pregnancy”
Linea nigra - dark pigmentation down center of abdomen
Striae gravidarum - stretch marks
Neurological changes during pregnancy?
Compression pelvic nerves
Carpal Tunnel Syndrome- 3rd trimester
Tension Headache
Psychological changes during pregnancy?
Maternal adaptation
Emotional Lability
Fatigue (hemodynamic & metoblic changes)
- ** Education- discuss normalcy of emotional mood swings and mixed feeling early in the pregnancy;
- s/sx depression review;
- encourage naps;
- exercise and healthy diet
Nursing management for Nausea and Vomitting?
N/V - usually between 4-5 week until 12th week
High hCG and progesterone levels & changes in carbohydrate metabolism
Avoid empty and overloaded stomach – eat more frequent smaller meals
Dry toast 30 minutes before getting out of bed
Hot drinks
Get up slowly
Avoid greasy foods
Sweet lemonade may help
Diclegis: Formerly Bendectin – off the market for 30 years, just returned to use in 2013 by FDA approval. It is composed of Vitamin B6 and an antihistamine-doxylamine.
Nursing management for heartburn?
Heartburn
Pressure of fetus on stomach and decreased GI tract motility lead to reflux
Low fat diet
Pat of butter before meals to inhibit excretion of acid in stomach
Eat several small meals rather than 3 large ones
Aluminum or magnesium based antacids
Sit upright after meals
Avoid coffee & cigarettes (stimulate acid secretion)
What do you want to do to help with flatulence in pregnancy?
Due to undesirable bacterial action
Eat small amounts of well-chewed foods
Avoid constipation
Avoid gas forming foods
How can you help with frequent urination during pregnancy?
Frequent Urination
Early & Late pregnancy
Encourage to drink fluids in morning & afternoons, decreasing fluids in evening
What can you do to help backache in pregnancies?
Backache
Teach good posture & body mechanics
Teach to bend from knees rather than back
Teach to wear shoes appropriate for activity
Exercises to strengthen back muscles
Nursing management for dyspnea in pregnancy?
Dyspnea
Encourage mom to prop up with pillows when in bed
Teach to sit & stand erect to lift diaphragm up
Nursing management of varicose veins in pregnancy?
Weight of fetus on saphenous veins of legs leads to increased pressure in veins
Can occur in legs & vulva
Prevention is easier than treatment
Avoid restricting clothing, knee-highs
Teach to elevate legs periodically
Good fitting elastic stockings are useful
Nursing management of leg cramps in pregnancy?
Pressure of enlarged uterus/fetus on nerves of lower extremities, fatigue, chilling
Decreased serum calcium, increased serum phosphorus
Decrease milk intake and supplement with calcium supplements (Milk increases phosphorus)
Aluminum hydroxide gel removes some phosphorus
Regular exercise
Immediate relief: dorsiflex foot & put pressure on knee to straighten leg
What are the potential complications during the first trimester?
First Trimester: Severe vomiting Chills, fever Burning on urination Diarrhea Abdominal cramping Vaginal bleeding
What are the potential complications during the second and third trimester?
Persistent, severe vomiting
Sudden discharge of fluid from vagina before 37 weeks
Vaginal bleeding, severe abdominal pain
Chills, fever, burring on urination, diarrhea
Severe backache or flank pain
Change in fetal movement
Uterine contractions; pressure; cramping before 37 weeksVisual disturbances: blurring; double vision, spots
Swelling of face or fingers and over sacrum
Headaches; sever, frequent, or continuous
Muscular irritability or convulsions
Epigastric or abdominal pain (perceived as heartburn or severe stomachache)
Glycosuria, positive glucose tolerance test reaction
What to avoid during pregnancy?
Avoid cat litter boxes – toxoplasmosis
Avoid exposure to infectious diseases
Avoid all drugs not prescribed during pregnancy
No alcohol
Avoid cigarettes – causes growth retardation
