Chapter 6 & 8 Flashcards
Exam 1
What causes uterine muscle fibers to grow in length and width?
estrogen
By 12 wks gestation, what can be palpated above the symphysis pubis?
the uterus
Where is the fundal height at 20 wks gestation?
at level of umbilicus- 20 cm
What is a reliable determination of gestational age until 36 wks gestation?
fundal height
After 36 wks gestation, why isn’t fundal height a reliable determinator of gestational age?
the uterus begins descending into the pelvis (the baby drops)
Where is the fundal height at 36 wks gestation?
at the xiphoid process
irregular, not real labor
Braxton Hicks contractions
softening of the cervix is called
Goodell sign
formation to prevent ascent of bacteria from vagina into the uterus
mucus plug
What is the increased vascularization of the cervix called and what does it look like?
Chadwick signs; bluish- purple in color
What happens to the vagina during pregnancy?
*Increased vascularity with thickening, vulva is thicker
*leukorrhea- secretions more acidic, white, and thick
What do the ovaries release to maintain pregnancy & to relax smooth muscle?
Progesterone
The cessation of ovulation is an inhibition of what?
FSH and LH
What increases in size and nodularity to prepare for lactation?
Breasts
What increases in size, becomes more erect and pigmented?
nipples
antibody-rich, yellow fluid that can be expressed after the 12 wk of pregnancy
colostrum
Conversion from colostrum to mature milk happens when?
after delivery
An adaption of the cardiovascular system during pregnancy is an increase in blood volume. What percentage above pre-pregnancy levels are seen?
50% above pre-pregnancy levels
An adaption of the cardiovascular system during pregnancy is an increase in venous return and an increase in HR which leads to an increase in what?
cardiac output
What cardiovascular abnormality is normal in pregnancy?
a murmur
An adaption of the cardiovascular system during pregnancy is an increase in the number of RBCs which can lead to what?
plasma volume > RBC; leading to hemodilation (physiologic anemia)
An adaptation of the cardiovascular system during pregnancy may be an increase in IRON demands, fibrin and plasma fibrinogen levels, and some clotting factors leading to what?
hyper-coagulable state- clots block perfussion that can be fatal to fetus
(increase in IRON demand may drive PIKA)
BP drops when woman lies down due to pressure of uterus on vena cava leading to what?
Vena Cava Syndrome
An adaption of the respiratory system during pregnancy may be breathing more from where?
diaphragm/ diaphragmatic breathing
The uterus pushes the diaphragm up how many centimeters during pregnancy?
4cm
What can cause pregnant women to be more susceptible to early decompensation?
asthma and other respiratory conditions
Which hormone relaxes smooth muscles in the airway?
Progesterone
Which hormone leads to nasal stuffiness?
estrogen
What happens with the gums during pregnancy?
hyperemic, swollen, and friable from estrogen
What is excessive salivation?
Ptylalism
A decrease in peristalsis is caused by what and what can be a result?
from smooth muscle relaxation (progesterone); constipation
What factors cause hemorrhoids in pregnancy?
constipation + increased venous pressure + pressure from uterus
What is the result of slow gastric emptying?
heartburn
Why does renal plasma flow increase in pregnancy?
to remove metabolic wastes from patient and fetus
What happens with the kidneys when pregnant women lie down and is greater with the left-lying position?
an increase in activity
monitored during pregnancy (in urine)
protein
hyperpigmentation is from what hormone?
melanocyte-stimulating hormone
“mask of pregnancy”
facial melasma
dark line on abdomen
linea nigra
stretch marks
striae gravidarum
varicose veins
varicosities
caused by darkening of the blood flow
vascular spiders
The circulation to skin increases making the patient feel what?
warmer and perspire more
What happens to the ligaments holding sacroiliac joints and pubis symphysis?
softening and stretching
What happens when there is increases of swayback and upper spine extension?
postural changes
What happens to the center of gravity in someone who is pregnant?
their center of gravity shifts forward
increase in lumbosacral curve
lordosis
What happens with the spine column during pregnancy?
an increase in lumbosacral curve (Lordosis); compensatory curve in cervicodorsal area
Relaxation and increased mobility of joints due to the hormone Relaxin causes what type of gait in pregnancy?
waddle gait
What happens to the thyroid gland during pregnancy?
a slight enlargemen; increased activity nec for fetal neurologic function
What happens in the pituitary gland during pregnancy?
an increase in Prolactin, inhibition of FSH and LH; gradual increase in oxytocin with fetal maturation
What happens with the pancreas during pregnancy?
the fetus makes demands on maternal glucose stores (glucose levels will be monitored)
What happens in the adrenal glands during pregnancy?
there is an increase in cortisol
Cortisol regulates what?
carbohydrates and protein metabolism
What does the placenta secrete?
hCG, hPL (human placental lactogen), relaxin, progesterone, estrogen
Presumptive Signs
*fatigue
*breast tenderness
*n/v
*amenorrhea
*urinary frequency
Presumptive signs are…..
subjective
Probable signs are…..
objective
Probable signs
*Braxton Hicks contractions
*Positive pregnancy test
*Abdominal enlargement
*Ballottement
*Goodell sign
*Chadwick sign
*Hegar sign
bluish- purple coloration of the vaginal mucosa and cervix
Chadwick sign
softening of the cervix
Goodell sign
softening of the lower uterine segment or isthmus;
Softening of the lower uterine segment that allows it to be easily compressed at 6 to 8 weeks of pregnancy.
Hegar sign
human chorionic gondadotropin
hCG
What usually doubles every 48- 72 hrs in normal pregnancy until they peak at 60- 70 days after fertilization?
hCG levels
What is used a marker to see how the pregnancy is progressing and help differentiate normal pregnancy from abnormal?
hCG
Positive signs
*ultrasound verification of embryo or fetus
*fetal movement felt by experienced clinician
*auscultation of fetal heart tones via doppler
Psychological Responses during the 1st Trimester
*Uncertainty (seeks to confirm pregnancy)
*Ambivalence (conflicting feelings)
*Introversion (thoughts are of themselves)
Psychological Responses during the 2nd Trimester
*Physical changes happen that make it “real”
*Fetus becomes primary focus
*Introversion remains
*Change in body image
*Change in sexuality
Psychological Responses during the 3rd Trimester
*Feelings of vulnerability
*Increased dependence on partner
*Preparation for birth
The patient must accept what and the changes that will result from it?
Then they must develop what with the unborn child?
the pregnancy; a relationship
Parental role transition is the realization that they must give up what in order to do what?
certain aspects of their life, take on a new identity as a parent (stages of grief)
Parental tasks of pregnancy
1) seek safe passage for oneself and baby
2) gain acceptance of the baby and oneself from partner and family
3) learning to give of oneself
4) developing attachment and connection with the unknown child
Although partners do not experience biologic processes of pregnancy they must do what?
must make major psychosocial changes to adapt to new role
Partner Adaptations to pregnancy:
they can be _______ invested and _______ involved in pregnancy, labor, and parenting
emotionally; actively
What are some questions the partner/ mother could be asking in regards to readiness for parenthood?
-financial security
-stable relationship between partners
An unplanned pregnancy could cause what in the relationship?
distress
To help the expected parents during the adaption to pregnancy phase, offer what to them?
-support groups for expected parents
-parenting classes
Siblings reactions are…
age- dependent
There may be what between the siblings with the introduction of the new infant into the famly?
rivalry
What is imperative especially for toddlers before the new baby is born or introduced?
sibling preparation
Adolescent siblings may exhibit what towards their parents?
embarrassment that their parents are sexually active
Adolescent siblings may only care about themselves unless it what?
affects them or their activities
Can adolescent siblings take an active role and want to help with the new baby?
yes
Teenage pregnancies can be a challenge due to what psychosocial factors?
identity vs confusion
multiple pregnancies
multiparity
Descent of the fetal head into the pelvic cavity before labor.
lightning
The first movements of the fetus felt by the pregnant client.
quickening
:a sudden tap on the cervix during vaginal examination may cause the fetus to rise in the amniotic fluid and then rebound to its original position
;a strong indication of pregnancy, but it may also be caused by other factors such as uterine or cervical polyps.
ballottement
healthy weight BMI
25 to 35 lbs
What is a healthy average of weight gain through the 2nd and 3rd trimesters?
1lb/ wk
If a patient has a BMI <18.5, then how much weight are they recommended to gain?
28- 40 lbs
If a patient has a BMI <18.5, what is the average amount of weight gain per week?
+1lb/ wk
If a patient has a BMI >25, then how much weight are they recommended to gain through the 2nd and 3rd trimesters?
<1 lb/ wk
What kind of effect does nutritional intake have on fetal well-being and birth outcome?
direct effect
What should the mother take from the beginning of the pregnancy until after delivery?
vitamin and mineral supplement/ daily
What are the dietary recommendations for expected mothers?
*prenatal vitamins (iron and folic acid)
What is the prenatal vitamins needed for?
fetal growth and brain development
Prevents neural tube defects (spina bifida and anencephaly)
Folic acid
The use of artificial sweeteners such as stevia, aspartame, saccharin should be what?
what to the MD, as it is debated
What foods should woman avoid in preganancy?
*some fish due to mercury content (shark, swordfish, king mackerel, ahi tuna)
*foods causing Listeriosis (soft cheeses- brie, feta, blue-veined cheese; hotdogs, lunch meats; smoked seafood
cause miscarriage
Listeriosis
daily Caffeine intake recommendation
300mg
