Antepartal Period Flashcards
How many weeks are each trimester
13 weeks
How long is the antepartal period
9 calendar months , 40 weeks average
What are signs called that the mother can perceive? What is an example
Presumptive signs. Absence of mensturation is most obvious sign
Rebound of unengaged fetus
Ballottement
Signs of pregnancy that can be detected by a physical exam by a health care professional. What is an example
Probable signs.
Hegar’s sign, Goodells sign, Chadwick’s sign
Softening and compressibility of lower uterus
Hegar’s sign
Softening of the cervical tip
Goodell’s sign
Bluish-purple coloration of vaginal mucosa and cervix
Chadwick’s sign
What kind of signs are pregnancy test?
Probable sign
What are some positive signs of pregnancy
Visualizing fetus by ultrasound, palpating fir fetal movements, and hearing fetal heartbeat
Spontaneous, irregular, painless contractions. They are false contractions and usually relieved by walking
Braxton Hicks Contractions
Lower portion of the uterus
Isthmus
Excessive salivation
Ptyalism
Promotion of the health and well being of a woman and her partner before pregnancy
Preconception care
The state of being pregnant
Gravid
A pregnant woman
Gravida
The number of deliveries at 20 week or greater the woman has, regardless whether the newborn was born alive or dead.
Para
A thin brownish black pigmented line running from the umbilicus to the symphysis pubis
Linea nigra
When can hCG production start? When can it be detected?
Can start as early as the day of implantation and can be detected as early as 7-10 days after conception
What can higher levels of hCG indicate?
Multifetal pregnancy, ectopic pregnancy, or a genetic abnormality
What can lower levels of hCG indicate?
Miscarriage
What you use to look for presence of hCG
Urine or serum test
What is Nägele’s rule
Take the first day of woman’s last menstural cycle, subtract 3 months, and then add 7 days and 1 year, adjusting the year as necessary
How do you measure fundal height? What does fundal height tell you?
Measure in centimeters from the symphysis pubis to the top of the uterine fundus (between 18 and 32weeks of gestation). This approximates the gestational age
Number of pregnancies
Gravidity
A woman who has never been pregnant
Nulligravida
A woman in her first pregnancy
Primigravida
A woman who has had two or more pregnancies
Multigravida
No pregnancy beyond stage of viability
Nullipara
Has completed one pregnancy to stage of viability
Primipara
Has completed two or more pregnancies to stage of viability
Multipara
Stretch marks most notably found on the abdomen and thighs
Striae gravidarum
What are reproductive changes that occur in pregnant woman
Uterus increases in size and changes shape and position. Ovulation and menses cease during pregnancy.
Cardiovascular changes in pregnant woman
Cardiac output and blood volume increase (45-50% at term) to meet the greater metabolic needs. Heart rate increases during pregnancy.
Respiratory changes in pregnant woman
Maternal oxygen needs increase. During the last trimester, the size of the chest may enlarge, allowing for lung expansion , as the uterus pushes upward. Respiratory rate increases and total lung capacity decreases
What happens to pelvic joints during pregnancy
They relax
What can cause nausea and vomiting during pregnancy?
Hormonal changes and increase in pressure within the abdominal cavity as pregnant clients stomach and intestines are is displaced within the abdomen
Why may constipation occur during pregnancy
Increased transit time of food trough the gastrointestinal tract and thus increased water absorption
What kind of organ does placenta become? What does it produce?
Becomes an endocrine organ that produces large amounts of hCG, progesterone, estrogen, human placental lactogen, and prostaglandins
What does blood pressure do during the second trimester of pregnancy
Decreases 5-10 mm Hg for both diastolic and systolic
When should blood pressure return to baseline range after how long
Approximately 20 weeks gestation
When does pulse increase during pregnancy
Increases 15-20 around 20 weeks gestation and remains elevated throughout remainder of pregnancy
What changes occur with breasts
Increase in size and areolas darken
Pigmentation increases on the face
Chloasma
What may cause episodes of maternal hypotension
Due to the weight of the uterus on the vena cava, this decreases venous blood flow to the heart
When should urine pregnancy test be done
First voided morning specimen to provide most accurate results
When can the FHR be heard on Doppler?
10-12 weeks gestation
When can FHR be heard with an ultrasound stethoscope?
16-20 weeks gestation
Where do you listen to hear FHR
At midline, right above the symphysis pubis, by holding stethoscope firmly on the abdomen
When can you measure fundal height
After 12 weeks gestation
When can you begin assessing for fetal movement
Between 16-20 weeks gestation
What does CBC with differential, Hbg, and Hct detect
Detects infection and anemia
How much water should pregnant woman consume
2-3 L of water each day from food and beverage source
I’m third trimester how should you instruct mother to count fetal movement/kick counts
2-3 times a day for 60 minutes each time. Fetal movements of less than 3 per hour or movements that cease entirely for 12 hours indicate a need for further evaluation
Ptylism
Increased or excessive saliva
Least reliable signs of pregnancy
Presumptive signs
Why should pregnant women not use saunas
Expose women to bacteria and increase risk of fetal tachycardia and raise the maternal temperature
Hormone that inhibits the formation of urine via vasoconstriction
Vasopressin
Pregnant women may experience discomfort resulting from variocosities of the rectum that are called _____.
Hemorrhoids
What is a oral anticoagulant that is used for the blood clotting and it is a known teratogen?
Warfarin
The pituitary gland is also called the _____.
Hypophysis
Emptying time of the gallbladder is ______.
Prolonged
The pregnant woman may experience ______ is dependent areas
Edema
The compulsive ingestion of no food substances is referred to as _______.
Pica
__________ is a hormone that contributes to the development of constipation during pregnancy
Progesterone
Hormone released by the posterior pituitary gland and is responsible for contractions
Oxytocin
What is the complaint that may be caused by a decrease in unconscious swallowing during nausea
Ptyalism
Goodells sign is described as _______ of the cervix
Softening
What is increased vaginal secretions that occur during pregnancy called
Leukorrhea
What position do you use for pelvic exam
Lithotomy
A pregnant women who withdraws and becomes increasingly preoccupied with herself and her fetus is experiencing what?
Introversion
What hormone is called the “hormone of pregnancy”
Progesterone
This hormone is believed to be a contributor in nausea and vomiting
TSH
What is a vaccine that is contraindicated during pregnancy
Rubella
Leukorrhea helps decrease most infections but what type of infection does it increase?
Fungal infections
What is quickening?
When mother feels baby kicking. 16-20 weeks
Glycoproteins produced initially by the yolk sac and the fetal gut, and later predominately by the fetal liver
Alpha-fetoprotein
Involves transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis
Amniocentesis
What is a procedure obtaining a sample of the chorionic villi for prenatal evaluation of chromosomal disorders, enzyme deficiencies, and fetal gender determination and to sex linked disorders
Chronic villus sampling (CVS)
What uses a real-time ultrasound to allow assessment of various parameters of fetal well-being
Biophysical profile (BPP)
A birth without pain reliving medications
Natural birth
What are 6 presumptive signs of pregnancy
Amenorrhea, N/V, exercise fatigue, urinary frequency, changes in breasts, quickening
What should you tell a woman who is complaining of nausea?
Keep dry crackers by bed and eat before getting up, watch spicy foods, eat small amounts, and get up slowly
Is there a increase or decrease vascularization with cervical changes
Increase vascularization
What is McDonalds sign?
Ease flexing of uterus. It is moving cervix easily and then there is easily flexion of uterus
What is Von Braun-Fernwald’s sign
clinical sign in which there is an irregular softening and enlargement of the uterine fundus during early pregnancy.
What are 4 probable signs of pregnancy
Cervical changes with increased vascularization, enlargement of abdomen, Braxton-Hicks Contractions , positive pregnancy test
What are 3 positive signs of pregnancy
Fetal heartbeat, Leopolds Maneuvers where fetal movement is palpated by caregiver, Ultrasound
What does a positive pregnancy test detect?
hCG
What does a cervix look like in a healthy woman? What about when she gets pregnant?
In healthy woman cervix looks nice and pink and during pregnancy it turns a bluish, purple
When can you visualize fetal parts/movement with ultrasound? When can you see gestational sac?
Fetal parts/movement @ 8 weeks
Gestational sac @ 4-5 weeks
What does enlargement of uterus deal primarily with early? What about after that?
Early it deals with myometrial hyperplasia (cells developed) and then hypertrophy ( cells getting bigger)
Does the isthmus hypertrophy?
No!
What are two concerns with enlarged uterus
Vena cava syndrome and supine hypotension
When the uterus pushes against the diaphragm what can this cause
Shortness of breath
What is lightening? What happens?
Uterus grows out and then sinks down into pelvic area. Breathes faster and frequency of urination.
What four things happen with the stretching and growth of the uterus
- Increased circulatory requirements (80-90% blood flow to placenta)
- Diameter of main uterine article doubles
- Increase size and number of blood and lymphatic vessels
- Uterus in pelvic cavity for first 3 months
Spontaneous, irregular, intermittent contractions; begins early in pregnancy then, throughout pregnancy
Braxton-Hicks Contractions
What is a mucous plug
Thick, tenacious mucus that seals the endocervical canal
When is the mucus plug expelled
When cervical dilation begins
What is white, cheesy patches in mouth of newborn
Thrush
What does estrogen influence with vagina
Hypertrophy and vascularization
How early can colostrum be expressed
Early as 12 weeks , it’s the first secretion
What is a medication that is given to Rh negative woman at 28 weeks gestation and within 72 hours of delivery
Rhogam
Stretch marks that may occur with growth and connective tissue changes
Striae
How does corpus luteum develop
From a ruptured follicle
Corpus luteum- ova becomes fertilized by sperm and creates
Corpus luteum is maintained with ______. If egg is fertilized to produce _______ regress approx 6-7 weeks and _______ takes over to produce progesterone
Corpus luteum is maintained with hCG. If egg is fertilized to produce progesterone regress approx 6-7 weeks and placenta takes over to produce progesterone
What do progesterone and estrogen influence with mouth
Gingivitis and soft, hyperemic gum tissue=bleeding
Reflux of acidic secretions
Pyrosis (heartburn)
How much increased blood volume is there by 30 weeks?
Over 50% pre-pregnancy level
There is a increased plasma and erythrocytes so what does the woman need?
Iron
Cardiac output increases ____-_____% over pregnancy levels and peaks around _____ weeks
Increases 30-50% and peaks around 32 weeks
Does the pulse increase or decrease?
Increases. 10-15 BPM by 14-20 wks
What does blood pressure do during pregnancy?
Decreases. It is lowest at mid pregnancy and then increases to pregnant level until term
What can you tell a woman to do who has dependent edema and varicose vein formation?
Support hose, put feet up often, check diet for amount of sodium she is having
Reduced blood pressure that can occur in women who lie down on their back which causes the uterus to compress the vena cava
Supine hypotensive syndrome
What does increased fibrin and plasma fibrinogen cause during pregnancy
Hypercoagulable state
What is physiological anemia of pregnancy? Why does it occur?
Blood volume increases and the woman’s RBC increases a little but not as much and blood volume which makes it look like woman has anemia. Usually you don’t have to treat, but you encourage her to take a prenatal vitamin
Breathing changes from abdominal to ________
Thoracic (diaphragmatic) - deep;faster
Tidal volume / volume of inhaled air increases which causes what? What actions should you take?
Hyperventilation. Sit her down and slow her breathing down
Estrogen induced edema and vascular congestion of nasal mucosa puts woman at risk for? Nursing implications?
Epitaxis (nosebleeds)
Lean forward, pressure on nose, ice pack
Melasma of chloasma on forehead and cheeks. What is this called?
Mask of pregnancy
What is skin pigmentation affected by?
Estrogen, progesterone, and melanocyte-stimulating hormones
What are vulvular changes
It looks darker
What is vascular spider nevi
Veins that look broken down on dependent areas or abdomen
What are the changes in the musculoskeletal system influenced by
Relaxin, progesterone, fetal growth, and maternal weight
What does relaxation of pelvic joints cause
Waddling
What can softening and stretching of ligaments in pelvis cause?
Round ligament pain. Pain in the lower abdomen and legs. Get woman off her feet, use support hose
What postural changes occur?
Increased swayback
Center of gravity changes ( increased lordosis)
What is diastasis recti
Abdominal muscle separating, can happen late in pregnancy and post partum
What are important teaching points for woman with diastasis recti
Need to tone after, post partal exercises, help her learn to push if happens before baby is born
What is the process of an accurate fundal height measurement
Use non stretch tape and measure distance from top of pubic bone to top of uterus (aka fundus)
Usually if you get a fundal height measurement of 20 cm you can assume the gestational age is 20 weeks. When would this not apply
After 36 weeks due to lightening
For twins, too much fluid, or tumors
Facilitates lactogenesis
Prolactin
Stimulates cell hormone
GH
Stimulates uterine contractions; milk ejection
Oxytocin
FSH and LH are inhibited by ____
hCG
TSH is ______ in the 1st trimester
Reduced
Stimulating hormone that increases pigmentation
Melanocyte
Inhibits urine production and increases BP
ADH (vasopressin)
How does pancreas work to produce insulin?
Works on supply-demand mode. Maternal insulin does not cross the placenta
The realization of a pregnancy can lead to fluctuating responses, possibly at the opposite ends of the spectrum
Ambivalence
Focusing on ones self, this is common during the early part of pregnancy
Introversion
Emotional lability is characteristic throughout most pregnancies
Mood swings
What food should women avoid in pregnancy?
Fish with moderate to high mercury level
Foods that risk getting listeriosis
Cold hot dogs or lunch meat
Soft cheeses
How much folic acid is needed during pregnancy
800 mcg/day
How much ferrous iron is needed during pregnancy
30 mg/day
How many more calories do woman need during pregnancy
300
What is normal weight gain during pregnancy
25-35 pounds
What could lack of folic acid lead to
Neural tube defects
An ultrasound is the most common
Diagnostic test
What can an ultrasound detect
Confirm pregnancy
Assess for congenital abnormalities
Assess fetal size and growth
Assess for placental location
There are five different measurements for fetal growth, what are they
Crown-rump length Biparietal diameter (BPD) Femur length Abdominal measurement Head/abdominal ratio
BPD is the most common measurement for fetal growth, what is this
The diameter of the head between the two parietal eminences
What makes up the 5 fetal biophysical variables
Fetal movement Fetal tone Fetal breathing Amniotic fluid volume NST normal
What is the normal fetal heart rate measurment
110-160
Nuchal translucency screening is what
An ultrasound to assess for nuchal translucency (looking at chromosomes) due to subcutaneous fluid accumulation behind fetal neck
When does the pregnant women usually think she feels quickening
16-20 weeks
What are the two things that are considered feeling quickening
10 movements per hour
Left lateral position, after a meal, 4 movements in an hour
How should a women count her movements she feels per hour
At same time
Count until you feel 10
Record them
What is a non stress test
Indirect measurement of uteroplacental function by trained personnel
Amniocentesis
Transabdominal puncture of amniotic sac for amniotic fluid after ultrasound
If amniocentesis is done between 11-14 weeks what are they looking for
Abdominal and fluid leakage
Detect generic abnormality
Amniocentesis done between 15-20 weeks
Most common time
Chromosomal and biochemical determination
Amniocentesis during 3rd trimester
Assess lung maturity
Chronic villus sampling
Obtain sample of chronic villus for PN elevation disorders
Chromosomal, enzyme or sex linked, fetal gender
Percutaneous umbilical blood sampling (PUBS)
Allows rapid chromosomal analysis test
When would you do a PUBS
Coagulation study Blood typing CBC Blood disorders Women at risk for genetic abnormalities
Risks with PUBS
Bleeding puncture site Cord laceration Hematomas Thromboembolism Infection Labor
What intervals should a pregnant women be seen
Every 4 weeks up to 28 weeks
Every 2 weeks from 29-36 weeks
Every week from 37 weeks to birth
Is exercise or working allowed during pregnancy
Yes, both are fine. The mother should not do more than she can handle
What can a women do to lessen the chance of nausea upon awakening
Eat dry crackers before getting out of bed and get up slowly
When it comes to washing the breast, what teaching points should you give a mother
Wash with warm water and do not use soap. Soap will dry out the nipple
What is increased thyroid hormone critical for?
Fetal brain and neurological growth
What changes happen with thyroid
Increased size and activity
What does a Doppler flow study show
Movement of red blood cells in vessels
What is alpha-fetoprotein analysis
Glycoprotein-form yolk sac and fetal gut; later fetal liver
What are biomarker screening tests for all pregnant women with AFP at different weeks for
10-14 weeks- amino fluid
12-14 weeks- maternal serum
16-18 weeks- optimal time to assess
What could AFP readings be influenced by
Number of fetuses
Gestational age
Low maternal weight
Race
Elevated levels of AFP usually are linked to
Neural tube defects
What are we worried about if we see nuchal translucency on an ultrasound
Trisomy 21,18,31
Skeletal issues
Cardiac issues
Neurological issues
What do we want to see when performing a non stress test
At least 2 fetal movements with increased fetal heart rate 15 bpm greater than normal for at least 15 seconds over a20 minutes period
Contraction stress test
Not preformed often
Mother given small dose of oxytocin
What do we want to see with a contraction stress test
Uterine contractions in 10 minutes without fetal heart rate decelerations
NEGATIVE TEST IS GOOD
Lecithin/ sphingomyelin deals with lung maturity. What must the ratio be with these to have mature lungs
2:1
2 lecithin to 1 sphingomyelin
Source of amniotic fluid
Fetal urine
