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Women's Health Test III > Chapter 7 > Flashcards

Chapter 7 Flashcards

1
Q

how does the uterus grow during pregnancy?

A
  • starts at 70g w/ capacity of 10 mL and by term, it weighs 1100-1200 g and holds 5 L
  • growth is the result of hyperplasia and hypertrophy
    • early in pregnancy: hyperplasia occurs due to estrogen and growth factors
    • late in pregnancy: hypertrophy occurs as muscle fibers stretch to hold fetus
  • the muscle also inc in strength as amount of elastic tissue inc and muscles in the myometrium expand in length and width
  • the wall of the uterus gradually thins out
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2
Q

pattern of uterine growth

A
  • the growth helps confirm the EDD
  • by 12 weeks: can palpate uterus above symphysis pubis
  • by 16 weeks: fundus midway b/w symphysis pubis and umbilicus
  • by 20 weeks: fundus at the umbilicus
  • by 36 weeks: fundus at the xiphoid process
    • pushes against the diaphragm–>shortness of breath
  • by 40 weeks: lightening occurs, and uterus sinks to a slightly lower level
    • makes breathing easier
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3
Q

contractility and uterine blood flow throughout pregnancy

A
  • throughout pregnancy, uterus undergoes Braxton Hicks contractions
    • these are infrequent and during first 2 trimesters, they aren’t felt
    • later in pregnancy, they may be more frequent and uncomfortable
  • as uterus enlarges, number and size of blood vessels inc
    • delivery of materials needed for fetal growth depends on adequate perfusion
    • by term, 1200 mL of blood per min reach the placenta
    • maternal blood carried by myometrial arteries–>intervillous spaces–>O2 and nutrients transferred to chorionic villi–>fetus
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4
Q

how does the cervix change during pregnancy?

A
  • water content and vascularity of the cervix inc
  • hyperemia (congestion w/ blood) occurs due to inc estrogen and results in bluish purple color that extends to vagina and labia
    • this discoloration is called Chadwick sign (early sign of pregnancy)
  • Goodell sign: cervical softening
  • glandular walls bcome thin and widely spaced and these spaces fill with mucous which becomes the mucus plus: filled with lots of immunoglobulins and blocks the ascent of bacteria
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5
Q

how does the vagina and vulva change during pregnancy?

A
  • inc vascularity causes the vaginal walls to appear bluish purpple
  • connective tissue softens and allows the vagina to distend
  • vaginal mucosa thickens and vaginal rugae become prominent
  • vaginal cells contain inc amounts of glycogen which causes rapid sloughing and inc thick, white, vaginal discharge
  • vaginal pH is acidic from inc production of lactic acid which helps prevent bacterial growth
    • but the glycogen rich environment sometimes allows growth of fungi, so yeast infections are common
  • inc vascularity can lead to heightened sexual interest
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6
Q

how do the ovaries change during pregnancy?

A
  • progesterone must be released to maintain pregnancy to suppress uterine contractions and prevent tissue rejection of the fetus
    • after conception, the corpus luteum secretes progesterone during first 6-7 weeks
    • b/w 6-10 weeks, placenta starts taking over and the corpus luteum regresses
  • ovulation ceases b/c of inc estrogen and progesterone which suppress LH and FSH
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7
Q

how do the breasts change during pregnancy?

A
  • estrogen stimulates the growth of mammary ductal tissue
  • progesterone stimulates the growth of lobes, lobules, and alveoli
  • breasts become highly vascular
  • striae may develop if breast size inc drastically
  • nipples inc in size and become darker and more erect
    • areolae become larger and more pigmented
  • tubercles of Montgomery (sebaceous glands) become more prominent and secrete colostrum as early as 16 weeks of gestation
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8
Q

how does the heart change during pregnancy?

A
  • cardiac changes are minor and reverse after childbirth
  • muscles of the heart enlarge during the first trimester
    • heart is pushed up and to the left as the uterus pushes up into diaphragm
  • some heart changes may be altered starting during 12-20 weeks and continue for 2-4 weeks after childbirth
    • most common includes splitting of the first heart sound or a systolic murmur best heard at the left sternal boarder
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9
Q

blood volume during pregnancy

A
  • inc begins by 6 weeks gestation
  • reaches an average of 30-45% during pregnancy
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10
Q

plasma volume during pregnancy

A
  • inc from 6-8 weeks until 32 weeks gestation
  • 40-60% greater than in non-pregnant women
  • may be due to vasodilation from nitric oxide, and estrogen, progesterone, and PG stimulation of RAAS
  • inc volume is needed to:
    • transport nutrients and O2 to the placenta
    • meet the demands of expanded maternal tissue
    • provide a reserve to protect the pregnant women from blood loss
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11
Q

red blood cell volume during pregnancy

A
  • RBC inc 20 to 30% above prepregnancy values
  • although both RBC volume and plasma volume expand, the inc in plasma vol is more pronounced and occurs earlier
    • this resulting dilution of RBC mass causes a decline in maternal H&H which causes physiologic anemia of pregnancy
      • ​may be protective against forming clots
  • need frequent lab tests to distinguish b/w physiologic anemia and true anemia
    • iron deficiency anemia can occur if Hgb is less than 11 in 1st and 3rd trimesters or 10.5 in 2nd
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12
Q

cardiac output and systemic vascular resistance during pregnancy

A
  • expanded blood volume of pregnancy results in an inc in CO (half the rise in CO occurs in first 8 weeks)
    • due to an inc in SV and HR (inc by 15-20 bpm by 32 weeks)
    • CO is hghest when women is lying on her side and is lower in the standing and supine positions
  • vascular resistance falls during pregnancy b/c
    • vasodilation resulting from effects of progesterone and PGs
    • addition of uteroplacental unit so greater area for circulation
    • inc heat production–>vasodilation
    • dec sensitivity to Ang II
    • endothelial prostacyclin and nitric oxide
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13
Q

blood pressure during pregnancy

A
  • BP is affected by position, so need to document her position when taking BP
    • SBP remains largeley unchanged if measured when sitting or standing
    • DBP shows a dec (10-15) that is greatest by 24-32 weeks and returns to normal at gestation
  • supine hypotension: weight of pregnant uterus occludes vena cava and aorta and diminishes return of blood, so CO is reduced
    • some women may develop lightheadedness, dizziness, nausea, syncope
    • may also cause fetal hypoxia if supine too long
    • turn to lateral recombent to correct
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14
Q

5 changes to blood flow during pregnancy

A
  • blood flow is altered to include the uteroplacental unit
  • renal plasma flow inc up to 30% to remove inc waste from fetus and mother
  • woman’s skin requires inc circulation to dissipate heat generated by inc metabolism during pregnancy
  • blood flow to the breasts inc resulting in engorgement and dilated veins
  • weight of expanding uterus on IVC and iliac veins can partially obstruct blood return from veins in legs
    • blood can pool and cause venous distention
    • can lead to varicose veins or hemorrhoids
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15
Q

blood components during pregnancy

A
  • iron absorption inc but not always enough in diet, so need supplementation
  • leukocytes inc to as high as 15000
    • postpartum can reach 25000-30000
  • pregnancy is a hypercoaguable state b/c of an inc in factors that favor clotting, like fibrinogen, factors 7, 8, 9, and 10
    • inc the ability to form clots
    • fibrinolytic activity dec
    • offers some protection from hemorrhage during childbirth
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16
Q

3 major respiratory changes during pregnancy

A
  • inc oxygen consumption: most is used by the fetus, uterus, and placenta
    • progesterone causes the woman to hyperventilate slightly by breathing more deeply
  • hormonal factors:
    • progesterone helps dec airway resistance and inc the sensitivity of the respiratory center in the medulla oblongata to CO2
    • estrogen causes inc vascularity of the mucous membranes
      • edema and hyperemia develop which may cause nasal stuffiness, epistaxis, deepening voice
  • physical effects of the enlarging uterus:
    • enlarging uterus lift diaphragm, ribs flare, substernal angle widens, transverse diameter expands
      • all results from the hormone relaxin
    • breathing becomes more thoracic rather than abdominal
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17
Q

GI system during pregnancy

A
  • appetite inc
  • mouth:
    • elevated levels of estrogen cause hyperemia of the mouth and gums and may lead to gingivitis and bleeding gums
    • some women experience ptyalism which is excessive saliva
  • lower esophagel sphincter tone decwhich may cause heartburn (pyrosis)
  • elevated levels of progesterone relax the tone and motility of the GI tract
  • gastric acidity dec during the first 2 trimesters and inc during the 3rd
  • emptying time of the intestines inc which allows inc nutrient absorption
    • may cause bloating and abdominal distention
    • also may cause constipation due to more water reabsorption in lg intestine
  • enlarged liver: alkaline phosphatase rises, albumin falls (likely due to hemodilution)
  • gallbladder becomes hypotonic: bile thickens and inc risk of gallstones
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18
Q

bladder in the pregnant woman

A
  • frequency and urgency of urination inc
    • if occurs with pain: may indicate infection
  • hormonal influences, inc blood volume, and changes in renal blood flow and GFR may cause inc urinary frequency
  • stress and urge incontinence may occur
  • bladder capacity doubles by term and tone is decreased in response to progesterone
    • nocturia is common
    • bladder walls become hypertrophied due to estrogen
    • dec drainage of blood from base of the bladder results in edema dn renders the area susceptible to trauma during childbirth
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19
Q

kidneys and ureters during pregnancy

A
  • kidneys change in size and shape due to dilation of the renal pelvis and ureters
    • dilation begins during 2nd month
    • ureters become elongated and are compressed b/w enlarging uterus
      • flow of urine is partially obstructed and this stasis can allow time for bacteria to grow
  • renal blood flow inc due to inc plasma volume and CO and is highest when woman lying on her left side
    • GFR inc due to higher renal blood flow
    • need this to excrete extra waste from fetus
    • glucosuria is common during pregnancy
    • urine output inc and mild proteinura is common
    • due to inc GFR: serum Cr and BUN dec
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20
Q

skin during pregnancy

A
  • circulation to the skin inc to dissipate excess heat
  • pregnant women feel warmer and perspire more
  • accelerated activity of sebaceous glands–>acne
  • inc pigmentation from inc estrogen, progesterone, and melanocyte stimulating hormone
    • may cause melasma (brownish patches on forehead, cheeks, nose) or linea nigra
    • moles, freckles, and areolae darken
  • blood vessels dilate and proliferate which is due to estrogen
    • angiomas may occur on areas exposed to the sun, palmar erythema may occur
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21
Q

connective tissue, hair and nails during pregnancy

A
  • striae gravidarum (stretch marks) may occur: fade to silvery lines after pregnancy
    • laser therapy may be able to be used after pregnancy
  • b/c fewer follicles are in the resting phase, hair grows more rapidly and less hair falls out during pregnancy
    • more hair loss can occur after childbirth, but returns to normal in 6-12 mos
  • nails may become brittle or softer
    • may grow faster or break more easily
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22
Q

musculoskeletal system during pregnancy

A
  • fetal demands for calcium inc, so absorption from intestine doubles–>only 28-30 g are transferred to fetus and this does not deplete maternal bone density
  • musculoskeletal changes are progressive
    • early in pregnancy: relaxin and progesterone initiate relaxation of the ligament
    • at 28-30 weeks: pelvic symphysis separates
      • inc mobility of pelvis causes waddling gait
    • during 3rd trimester, uterus inc in size and she must lean back to maintain balance
      • can create lordosis and backache
  • abdominal wall muscles may be stretched byond capacity and cause diastasis recti
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23
Q

who is at risk for diastasis recti?

A

–Previous abdominal surgery

–More than one pregnancy

–Multiples in pregnancy

–Increased weight gain in pregnancy

–Long pushing phase of labor

–Chronic coughing

–Chronic constipation

–Caucasian ethnicity

–Petite frame

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24
Q

pituitary gland during pregnancy

A
  • anterior pituitary inc in size
    • prolactin levels inc to prepare lactation
    • FSH and LH are suppressed by progesterone and estrogen
  • posterior pituitary releases oxytocin which stimulates contractions
    • progesterone inhibits this early in pregnancy
    • estrigeb causes a gradual rise in oxytocin receptors in the uterus to inc contractions near term
    • oxytocin also role in preventing postpartum hemorrhage
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25
Q

thyroid gland during pregnancy

A
  • hyperplasia and inc vascularity cause thyroid gland to enlarge
    • may show greater inc in size if iodine intake is insufficient
    • thyroid hormone levels inc
  • T4 rises early in pregnancy but returns to normal levels by end of first trimester
  • T3 and T4 both cross placenta
    • they are important for fetal neurologic function b/c the fetus does not make thyroid Hs until 12 weeks gestation
26
Q

pancreas during pregnancy

A
  • changes occur due to alterations in blood glucose levels and fluctuations in insulin production
    • blood glucose levels are lower than before pregnancy and hypoglycemia may develop
  • during the 2nd half of pregnancy, maternal tissue to insulin begins to decline b/c of effects of hCS, prolactin, estrogen, progesterone, and cortisol
    • mother uses fatty acids to meet tissue needs
    • fasting blood glucose level is decreased as glucose passes to fetus
    • post prandial blood glucose level is higher than before pregnancy making more glucose available for fetla needs
27
Q

adrenal glands during pregnancy

A
  • concentrations of cortisol increase due to the elevated estrogen and decrease in clearance rate of cortisol which prolongs the half life
  • aldosterone inc early in pregnancy which helps maintain the necessary level of sodium in the expanded blood volume
28
Q

human chorionic gonadotropin (hCG)

A
  • primary function is to prevent deterioration of the corpus luteum so that it can continue to produce estrogen and progesterone until the placenta can produce it
  • this is what causes a positive pregnancy test
29
Q

estrogen

A
  • early in pregnancy, it is produced by corpus luteum, then the placenta takes over
  • effects:
    • suppression of FSH and LH
    • stimulation of uterine growth
    • inc blood supply to uterin evessels
    • added deposit of maternal fat stores
    • inc uterine contractions near term
    • development of glands and ductal system in the breasts in preparation for lactation
    • hyperpigmentation
    • stimulation of vascular changes in the skin, rbeasts, respiratory tract, bladder
    • antagonist to insulin
30
Q

progesterone

A
  • produced first by corpus luteum, then placenta
  • effects:
    • suppression of FSH and LH
    • maintenance of endometrial layer for implantation of fertilized ovum and prevention of menstruation
    • dec uterine contractility to prevent abortion
    • inc fat deposits
    • stimulation of development of the breasts for lactation
    • relaxation of smooth muscle
    • inc respiratory sensitivity to CO2 to stimulate ventilation
    • suppression of the immunologic response which prevents rejection of fetus
    • antagonist to insulin
    • retention of sodium
31
Q

human chorionic somatomammotropin (hCS)

A
  • also called hPL
  • present in early pregnancy and inc throughout
  • inc the availability of glucose for the fetus
    • it is an insulin antagonist and reduces sensitivity of maternal cells to insulin which frees glucose for transport to the fetus
  • helps prepare breasts for lactation
32
Q

relaxin

A
  • produced by corpus luteum and placenta
  • present by first missed period
  • inhibits uterine activity, soften connective tissue in the cervix, and relaxes cartilage and CT to inc mobility of pelvic joints
33
Q

water metabolism during pregnancy

A
  • amount of water inc to meet the needs of fetus, placenta, amniotic fluid, and inc blood vol
  • kidneys must compensate for factors that influence fluid balance
    • inc GFR, PGs, dec plasma proteins, and inc progesterone all inc Na excretion
    • inc estrogen, cortisol, hCS, and aldosterone all promote reabsorption of Na
      • this helps maintain Na and water balance
34
Q

edema during pregnancy

A
  • b/c of hemodilution, edema develops during pregnancy
    • further inc toward the end of term when the weight of the uterus compresses pelvic veins which delays venous returns and causes veins in the legs to become distended–>inc venous pressure–>shifts fluid to interstitial spaces
  • edema especially obvious at the end of the day b/c of the force of gravity
35
Q

eye and ear during pregnancy

A
  • corneal edema may cause some women who wear contact lenses to have discomfort
    • resolves after childbirth
  • intraocular pressure dec which may cause improvement of glaucoma
  • changes in mucous membranes of eustachian tube from inc levels of estrogen may cause women to have blooed ear and mild hearing loss
36
Q

immune system during pregnancy

A
  • altered during pregnancy to allow the fetus to grow undisturbed w/o becoming rejected by the woman’s body
    • may lead to some autoimmune conditions like RA and MS to improve during pregnancy
  • resistance to some infections dec, but viral and fungal infections may inc
37
Q

presumptive signs of pregnancy

A
  • subjective changes that are experienced and reported by the woman
  • least reliable
  • includes:
    • amenorrhea
    • n/v: begins during first 4-8 weeks and resolves by 10-12 weeks–>due to inc hCG and estrogen
    • fatigue
    • urinary frequency (due to fluid vol changes)
    • breast changes: by 6th week (tenderness, tingling, fullness, inc size)
    • inc pigmentation of skin
    • Chadwick sign: inc pigmentation of cervix, vagina, and labia
    • fetal movement: don’t usually start until 2nd trimester
38
Q

possible indications of pregnancy

A
  • objective signs but may still have other causes than pregnancy
  • includes:
    • abdominal enlargement
    • Goodell sign: cervical softening
    • Hepgar sign: lower uterine segment softens about 6-8 wks after last menses
    • ballottement: during midpregnancy, sudden tap on cervix causes fetus to rise up then rebound
    • braxton hicks contractions
    • palpation of fetal outline
    • uterine souffle: soft blowing sound that is auscultated over the uterus caused by blood circulating; corresponds to maternal pulse
    • positive pregnancy test
39
Q

pregnancy tests

A
  • detect hCG which is present in maternal blood and urine shortly after conception
    • immunoassay tests: can detect 3-7 days after conception
    • home tests: best to use first morning voids b/c most concentrated
  • inaccurate pregnancy test:
    • false negative: when women is pregnant, but test shows negative
      • may occur if instructions not followed, too early in pregnancy, urine is too dilute, woman is taking diuretics
    • false positive: when woman is not pregnant, but test shows positive
      • may occur if hematuria, proteinuria, or some tumors, and some anticonvulsants and antiparkinsonian drugs
40
Q

positive indications of pregnancy

A
  • auscultation of fetal heart sounds: can be heart by 9-12 weeks w/ doppler
    • normal is 110-160 bpm during 3rd trimester
  • fetal movements detected by examiner: considered positive when detected by examiner b/c they are not likely to be deceived by peristalsis
  • visualization of embryo or fetus: using ultrasound
    • can use transvaginal U/S as early as 3-4 weeks gestation
41
Q

what are 2 major complications of inadequate antepartum care?

A
  • low birth weight
  • prematurity
42
Q

preconception and interconception care

A
  • ideally, first visit takes place before conception
    • can help identify problems that might harm mom or fetus
  • early weeks are particularly important b/c fetal organs forming and sensitive to harm
  • chronic conditions like asthma, obesity, DM, or hypothyroidism should be addressed before pregnancy
  • during preconception visit: complete hx, assess for health problems or harmful habits
    • can screen for rubella, varicella, and hep B
  • woman is advised to consume 400-800 mcg of folic acid daily at least 1 month before conception and 2-3 months after to prevent neural tube defects
    • 600 mcg for rest of pregnancy
    • if have had a baby with a NTD, take 4000 mg during 1 month before and during first trimester
43
Q

why is obesity a concern during pregnancy?

A
  • may inc incidence of:
    • HTN disorders,
    • GDM,
    • PPH,
    • poor labor progression,
    • C/S,
    • anesthesia complications,
    • wound infection,
    • LGA infants
44
Q

Carpal Tunnel Syndrome in pregnant women

A
  • occurs due to edema compressing the median nerve when the N passess thru the carpal tunnel
  • symptoms: pain, burning, numbness, tingling of hand and wrist
  • splinting of wrist at night may help
  • resolves by 3 mos after childbirth for most women
45
Q

mid stream clean catch done during prenatal visits

A
  • will test for:
    • protein: can indicate kidney dz, preeclampsia, or contamination of vaginal secretions
    • glucose: may be normal during pregnancy
    • ketones: may occur after heavy exercise or if inadequate food/fluid intake
    • bacteria: assoc with UTI
46
Q

when are subsequent assessments of antepartum care done?

A
  • traditional model if no complications:
    • conception to 28 weeks: every 4 weeks
    • 29-36: every 2 weeks
    • 37 weeks to birth: weekly
  • Centering Pregnancy: alternative method
    • involves 10 1.5-2 hour sessions w/ groups of women and a HCP beginning at 12-16 weels
    • women assess their own BP and weight and participate in educational sessions
    • social support is established
47
Q

what is assessed during subsequent prenatal assessments?

A
  • V/S
  • weight: if not enough–>fetus not growing, if sudden inc–>excessive fluid retention
  • urine: tested for protein, glc, ketones
  • fundal height: performed at each visit
    • bladder must be emptied, woman lies on back with knees bent
    • from 16-38 weeks, fundal height in cm is equal to gestational age of fetus in weeks w/in 3 cm
  • leopold maneuvers
  • FHR
  • fetal activity: quickening first noticed b/w 16-20 weeks
    • last trimester: woman should do kick counts
  • signs of labor should be reviewed
  • U/S
  • glucose screening at 24-28 weeks
  • isoimmunization
  • pelvic exam: during last trimester to determine progression
48
Q

multifetal pregnancy

A
  • more likely if the woman is older, African American, family/personal hx, conceived as result of infertility tx
  • signs: larger than expected for gestation, have more fetal movements, gain more weight
    • fundal height often 4 cm larger than expected
  • should confirm with U/S
49
Q

antepartum care with multifetal pregnancy

A
  • have more frequent antepartum visits to assess for HTN, preterm labor, abruption, placenta previa, GDM, anomalies, LBW, and PPH
  • U/S done Q4-6 weeks starting at 24 weeks
  • frequent assessment of cervical changes during 3rd trimester
  • nutritional education necessary b/c of inc calories, iron, Ca, folic acid, and vitamins needed
    • should gain 37-54 lbs with a twin pregnancy
50
Q

nausea and vomiting during pregnancy

A
  • morning sickness
  • often more acute in the morning
  • symptoms may be inc by odors, fatigue, or emotional stress
  • should reassure women that although morning sickness is distressing, common, temporary, will not harm fetus
  • must be distinguished hyperemesis gravidarum: accompanied by weight loss, dehydration, electrolyte imbalance, and ketosis
  • significantly intereferes with intake of vitamins so may need supplements
51
Q

backache during pregnancy

A
  • common during 3rd trimester due to inc joint mobility, lumbar lordosis, and relaxed ligaments
  • should educate about correct posture and body mechanics
52
Q

round ligament pain during pregnancy

A
  • sharp pain in the inguinal area or on the right side
  • results from softening and stretching of the ligament from hormones and uterine growth
  • often on the right, b/c the uterus turns towards the R during pregnancy due to pressure from rectosigmoid colon
53
Q

healthy behaviors during pregnancy

A
  • bathing protects women from infections and promotes comfort
    • but use non skid mats b/c prone to falls
  • avoid conditions that could cause hyperthermia (hot tubs) and douching (inc risk of infection)
  • breast care: use supportive bra, no soap on nipples (removes lubrication), breast stimulation inc oxytocin release (should not do if hx of preterm labor)
  • wear practical, comfortable, and nonrestrictive clothing
  • nutrition
54
Q

exercise during pregnancy

A
  • beneficial to strengthen muscles, reduce backache and stress, and provide a feeling of well being
  • can exercise in moderation for 30 min or more on most if not all days of the week
  • contact sports are not safe
  • do not do exercise in the supine position
  • walking is ideal b/c stimulates muscles, inc resp and CV effort, and does not result in fatigue
    • swimming is also good b/c prevents injury
  • should not begin strenuous exercise training
  • avoid becoming overheated
55
Q

employment during pregnancy

A
  • work should not lead to undue fatigue
    • need frequent rest w/ feet elevated
    • heavy lifting should be avoided
    • investigate occupational exposures to hazardous chemicals
56
Q

travel during pregnancy

A
  • car travel is safe
    • but should include no more than 6 hours/day
    • should stop to walk every 1-2 hours to empty her bladder and dec risk of thrombosis
    • use seatbelt
  • plane travel is safe up to 36 weeks if no complications
    • should use support stockings, periodic movement, avoid restrictive clothing, and inc hydration
    • wear seatbelt
    • walk at least once an hour
57
Q

immunizations during pregnancy

A
  • live vaccines are contraindicated like MMR and varcells
  • inactivated vaccines like tetanus, hep B, and influenza are safe
  • should receive flu vaccine and tdap vaccine during each pregnancy
    • tdap best if given b/w 27 and 36 weeks
58
Q

NSAIDs during pregnancy

A
  • avoid b/c may inc bleeding
59
Q

tobacco during pregnancy

A
  • identify women who smoke and explain the effects of smoking
  • make every effort to stop smoking and avoid contact w/ others who smoke
    • secondhand smoke inc risk of preterm birth, RDS, and NICU admission
  • can use 5A approach:
    • Ask woman at each visit if she smokes, how much, if she wants to quit
    • Advise about importance of not smoking
    • Assess woman’s willingness to stop smoking
    • Assist in making plan to stop smoking
    • Arrange f/u
  • include the partner!!!
60
Q

when is sexual activity contraindicated during pregnancy?

A
  • multiple pregnancy
  • threatened abortion
  • incompetent cervix
  • ruptured membranes
  • hx of PTL
  • partner with STD
61
Q

danger signs of pregnancy

A
  • gush of fluid
  • vaginal bleeding
  • abdominal pain
  • temp inc over 38.2 or 101
  • dysuria
  • persistent vomiting
  • change in frequency/strength of fetal movement
  • muscular irritability/convulsions
  • epigastric pain
  • oliguria
  • continuous pounding HA
  • dizzy, visual disturbance
  • edema:
    • hands, face
    • legs & feet: early pregnancy

Women's Health Test III (7 decks)

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