ch. 13: a&p of pregnancy

Question 1

What is viability?

Answer 1

capacity to live outside the uterus

Question 2

What is gravidity?

Answer 2

any pregnancy regardless of duration & outcome

-also includes current pregnancy

Question 3

What is Nagele’s Rule?

Answer 3

formula to estimate delivery date

1) FIRST DAY OF LAST NORMAL PERIOD
2) MINUS 3 MONTHS
3) ADD 7 DAYS

Question 4

What is the GTPAL method?

Answer 4

method to record a woman’s pregnancy hx using symbols

Question 5

What does the G stand for in GTPAL?

Answer 5

Gravida- # of total pregnancies regardless of length and outcome

Question 6

What does the T stand for in GTPAL?

Answer 6

Full Term (38-40 weeks)

Question 7

What does the P stand for in GTPAL?

Answer 7

Preterm (20-37 weeks)

Question 8

What does the A stand for in GTPAL?

Answer 8

Abortion (<20 weeks)

Question 9

What does the L stand for in GTPAL?

Answer 9

Living- # of total living children

Question 10

What is the earliest biological marker for pregnancy?

Answer 10

hCG

Question 11

What do elevated levels of hCG indicate?

Answer 11

abnormal gestation, Downs, or multifetal pregnancy

Question 12

What do lower levels of hCG indicate?

Answer 12

impending miscarriage, ectopic pregnancy

Question 13

What urine specimen is the best to use for a pregnancy test?

Answer 13

first one in the morning bc it contains almost the same level of HCG as blood

Question 14

What hCG blood levels are diagnostic for pregnancy?

Answer 14

> 25

Question 15

How is fundal height measured?

Answer 15

in cm from the pubic symphysis to the top of the uterus

-cm same as weeks up until week 40 when the fundus drops

Question 16

What hormones stimulate uterine growth?

Answer 16

estrogen and progesterone

Question 17

What are Braxton Hicks Contractions

Answer 17

• irregular and painless

- facilitate uterine blood flow

Question 18

What 3 factors decrease uterine blood flow?

Answer 18

1) low maternal arterial pressure
2) contractions of uterus
3) maternal supine position

Question 19

What is quickening?

Answer 19

first recognition of fetal movement, “feeling life”

Question 20

How much does cardiac output increase during pregnancy?

Answer 20

reaches max of 30-50% above nonpregnant level

Question 21

How much does the blood volume increase?

Answer 21

40-50%

Question 22

The increase in ____ is more than the increase in RBC mass

Answer 22

plasma volume

-results in hemodilution (physiologic anemia)

Question 23

How much does the WBC level increase?

Answer 23

• nonpregnant: 5k - 10k

- pregnant: 15k

Question 24

What coagulation changes occur during pregnancy?

Answer 24

-clotting factors 8, 7, 9, 10 DOUBLE
-fibrinogen increases
-fibrinolytic activity decreases
=HYPER-COAGULATIVE STATE

Question 25

Since pregnancy is a hyper-coagulative state, what are women at increased risk for?

Answer 25

5-6 fold ↑ risk for thromboembolic event

Question 26

What results from the enlarged uterus displacing the diaphragm up to 4 cm?

Answer 26

- diaphragm mobility reduced - resp become mainly thoracic - ↑ estrogen relaxes ribs, ↑ chest expansion

Question 27

How does increased vascularity affect the upper resp system?

Answer 27

nasal stuffiness, ears, nose bleeds, voice changes

Question 28

How is pulmonary function affected by increased estrogen and progesterone?

Answer 28

- CO2 threshold is lowered | - O2 demand and consumption is increased

Question 29

How is the acid/base balance affected?

Answer 29

- 5mm Hg decrease in pCO2= decreased HCO3, increased pH - pregnancy is a state of RESPIRATORY ALKALOSIS - this facilitates transport of CO2 from fetus to mom and O2 release from mom to fetus

Question 30

What are the anatomic changes of the renal system?

Answer 30

renal pelves and ureters are enlarged/dilated

Question 31

How does the GFR change in pregnancy?

Answer 31

GFR increases by 50%

Question 32

What is the result of the increased GFR?

Answer 32

↑ creatinine clearance & reduced serum creat, BUN & uric acid

Question 33

Why is Na retained?

Answer 33

to meet fetal needs, fluid expansion, & to maintain isotonic state

Question 34

Can you give diuretics to a pregnant pt?

Answer 34

NO! IT MAY DROP THE BP AND DECREASE PLACENTAL PERFUSION

Question 35

How is tubular reabsorption of glucose affected?

Answer 35

- it is impaired= glucosuria - nonpreg excrete 100mg/day - preg excrete 1-10 g/day ( still have to assess for gestational DM)

Question 36

What is the abnormal proteinuria level?

Answer 36

> 300 mg/24 hrs

Question 37

What is the abnormal albuminuria level?

Answer 37

> 30mg/ 24 hrs

Question 38

What happens if a woman has both proteinuria and HTN?

Answer 38

they are at risk for adverse outcome

Question 39

What are the effects on the GI system?

Answer 39

nausea, vomiting, indigestion. heartburn (pyrosis), increased r/o hiatal hernia, constipation