Antenatal Flashcards
How long the typical menstrual cycle?
28 days
need to assess length
Which hormone stimulates maturation of the egg?
follicle stimulating hormone (FSH)
Which hormone triggers the release of the egg/ovulation?
luteinizing hormone (LH)
Which hormone allows implantation?
progesterone
What marks the beginning of pregnancy?
union of a single egg and sperm (conception)
sperm can live in the tract for __ to __ days
2 to 4
Hormones produced by the placenta (4)
1) Human Chorionic Gonadotropin (hCG)
2) Human Placental Lactogen (hPL)
3) Progesterone
4) Estrogen
Human Chorionic Gonadotropin (hCG)
stimulates ongoing production of progesterone
Human Placental Lactogen (hPL)
stimulates breast growth and exerts lactogenic properties
Progesterone
maintains the endometrium around the fetus
increases the alveoli in the breast
keeps the uterus in a quiescent state
Estrogen
stimulates duct formation in the breast
increases the weight of the uterus
increases certain uterine receptors important to birth
Length of pregnancy in weeks
40 weeks
Pregnancies are computed from the 1st day of the __________
last menstrual period (LMP)
conception occurs approximately 2 weeks after the first day of the LMP
Nagele’s Rule
for computing estimated due date (EDD)
assumes normal cycle*
First day of LMP – 3 months back + 7 days + 1 year
OR
First day of LMP + 7 days + 9 months
How to determine EDD if period cycle isn’t normal
dating ultrasound around 8 - 12 weeks
Types of Signs and Symptoms of Pregnancy (3)
1) Presumptive
2) Probable
3) Positive
Presumptive Signs and Symptoms of Pregnancy
subjective changes reported by the patient
e.g. amenorrhea, tender breasts, nausea, fatigue, polyuria
could also be things like diabetes, stomach bug
Probable Signs and Symptoms of Pregnancy
objective changes by an examiner
Chadwick’s sign, Goodell’s sign, Hegar’s sign, positive pregnancy test
Positive Signs and Symptoms of Pregnancy
objective signs assessed by an examiner that can be attributed ONLY to the presence of the fetus
ultrasound, Dopplers - heart tones of fetus
Chadwick’s Sign
bluish or purplish discoloration of the vulva, vaginal tissue, or cervix
caused by increased blood flow
Goodell’s Sign
softening of the cervix
Hegar’s Sign
uterus becomes globular in shape, softens, and flexes easily over the cervix
Primigravida
client who is pregnant for 1st time
Multigravida
client who has had 2 or more pregnancies
Nulligravida
client who has never been pregnant
Gravida
TOTAL # of pregnancies prior PLUS present pregnancies regardless of gestational age, type, time or method of termination/outcome
pregnancy with twins/multiples is counted as 1 pregnancy
Term
Total # of previous pregnancies WITH BIRTH occurring at greater than or equal to 37 completed weeks
Preterm
Total # of previous pregnancies WITH BIRTH occurring between 20 + 0 and 36+7 completed weeks
Abortus
Total # of spontaneous or therapeutic abortions occurring prior to 20+0 weeks
spontaneous abortions include miscarriage, ectopic pregnancy, missed abortion, and molar pregnancy
Living Children
Total # of children the patient/client has given birth to that are presently living
Providers can include each child’s name in the free text
39 year old; one miscarriage, one birth at 23 weeks non live, 4 abortus prior to 20 weeks, 3 children at home, one set of twins born at 36 weeks; one singleton born at 41 weeks
GTPAL format
G: 8
T: 1
P: 2
A: 5
L: 3
T-ACE acronym meaning
for illicit drug use
T: Tolerance - how much to feel effect
A: Annoyance - being told to cut down
C: Cut down - feeling like they need to cut down
E: Eye opener - first thing in the morning
Concerning Findings in Pregnancy (many)
edema in face
unilateral edema in legs (DVT)
hyper-reflexive deep tendon reflexes (preeclampsia)
sudden vision changes (preeclampsia)
Expected findings during pregnancy (many)
weight gain
dyspnea
peripheral edema
constipation
hypotension
vaginal bleeding
bleeding gums
mammary souffle (heart murmur sound over breasts)
What is fundal height used to estimate?
fetal growth
Fundal height is measured from the _______ to the _______
symphysis pubic bone
top of the uterus (fundus)
At approximately how many weeks of gestation does the fundal height in cm correlate with the gestational age in weeks?
20 weeks
A pregnant individual at 30 weeks gestation has a fundal height of 26 cm. What is the most appropriate next step?
a) reassure the patient this is normal
b) schedule an ultrasound to assess fetal growth
c) perform a non-stress test immediately
d) measure blood pressure
b) schedule an ultrasound to assess fetal growth
First trimester length
0 to 12 weeks
Second trimester length
13 to 27 weeks
Third trimester length
28 weeks to birth
Leopold’s Maneuvers
used to assess fetal lie, presentation, attitude, position, and engagement
During which trimester are Leopold’s Maneuvers used?
3rd trimester
Fetal HR should be between ___ and ___ bpm
110 - 160 bpm
count for 1 full minute*
How to differentiate between fetal and maternal HR?
palpate the mother’s pulse while you listen
BP changes by trimester
1st
-pre-pregnancy values
-diastolic may decrease due to decreased SVR
2nd
-diastolic drops 10 - 15mmHg lower than pre-pregnancy
-especially with position changes, get up slowly
3rd
-rises to prepregnancy levels
HR changes by trimester
1st
-15 - 20 bpm higher
2nd
/
3rd
-15 - 20 bpm higher
-functional systolic murmur
How to frame questions related to abuse
“I ask everyone these questions because of my concern for all women.”
