dg of early and late pregnancy Flashcards
define pregq
phsyiological process in femals involed w/ the development of the femal sexual cell and course of growth of the embryo/fetus in maternal body
how long does pregnancy last for
9 months
40 weeks
280 days
pregnancy stages
early=2 weeks
mid= 13-27
late=27 weeks plus
term 37-42 weeks
3 trimesters of pregnancy
1st= 12 wks
2nd= 13-28wks
3rd=29-40wks
how to calculate the estimated due date
naegele’s rule
based on last menstrual period
naegel’s rule for april - dec
add7 days
minus 3 months
add one year
naegele’s rule jan0march
add 7 days
add 9 months
why is naegele;s rule innacurate
not everyone’s period cycle is 28 days
not everyone’s gestational period lasts 280 days
principles for dg
of early preg (1st trimester)
1) history & subjective symps
2) objective symps
3) immune tests
4) US
1) history & subjective symps of early preg
1) amenorrhea
2) morning sickness
3) urinary symptoms
4) breast sensation
5) fatigue
1) amenorrhea in early preg
1st and most important symp
other causes
- medications
chronic diseases
emtional tension
2)morning sickness in early preg
worst in the 6th week and stops after 12 wks
caused by
- HCG
- delayed gastric emptying
3)urinary symptoms
in early preg
frequency
nocturia
caused by increased pelvic circ
enlarged uterus increases pressure on the bladder
4) breast sensation in early preg
full
prickling sensation
pain
objective signs of early pregnancy
mastodynia
constipation(d/2 smooth muslce relaxing)
weight gain
pelvic changes
what is mastodynia
aka mastalgia is pain in the breast
caused by :
development of mammary duct and alveolar system
increased circulation and breast engorgment
+ larger breasts
+ darker areola
what are the pelvic changes in “dg of early pregnancy”
chadwick’s sign
vaginal sign
cervical sign
uterine sign
what is the chadwick sign in “dg of early pregnancy”
early preg sign 6-8 weeks
vagina and labia turn blue
d/2 accum of estrogen
what are the cervical signs of early pregnancy
softening and blue coloration
uterine signs of early pregnancy
enlarges and softens
- hegar’s sign
- palmar sign
hegars sign in “dg of early pregnancy”
*lower uterine segment above the cervix becomes so soft that when compressed between two fingers ( one abdominally other trans vaginally) its wall cannot be felt or feels extremely thin.
palmar’s sign in “dg of early
pregnancy”
rythmic uterine contraction elicited in bimanual exam at 4-8 wks
imunological tests in “dg of early
pregnancy”
measure HCG made by placenta
hcg antigen detected in urine/blood 8-9 days after fertilization
when do hcg levels peak in “dg of early
pregnancy”
2nd and 3rd months of pregnancy
Double every 2 days in 1st 10 wks
list the types of ultrasonography in pregnancy
trans vaginal
abdominal
when is the gestational sac seen on US in “dg of early
pregnancy”
5-6 wks after LMP
or 30-35 days gestation
by trans vaginal US
when is fetal heart beat seen on US in “dg of early
pregnancy”
7th week
doppler can also be used
when is fetus seen on US in “dg of early
pregnancy”
8th week
describe a true gestational sac
eccentric locatino
round and regular shape
double ring sign
yolk sac and fetal pole
size increases 1mm/day
significance of a pseudo GS
suggests ectopipc pregnancy
describe a false gesyational sac
central location
irregular shape
absent double ring sign
absent yolk sac and fetal pole
lack of size increase
what parameters are used to dg late pregnancy (2nd-3rd trimesters)
symptoms] general exam abdominal exam vaginal exam US exam
symptoms in late pregnancy
- amenorrhoea
- abdominal enlargement -loss of nausea and vom after 12 wks
- reduced HCG after 12 wks
- fetal movement after 20 wks
- braxton hicks
- palpation of fetal parts
- fundal height
what is fundal height
distance from the pubic bone to the top of the uterus measured in centimeters. After 20 weeks of pregnancy, your fundal height measurement often matches the number of weeks you’ve been pregnant.
what is observed on gen exam in late preg
chloasma at the 24th week
increased breast enlargment
define chloasma in “dg of late
pregnancy”
mask of pregnancy is a tan or dark skin discoloration d/2 hormone change
abdominal exam in late pregnancy
inspection
inspection
- striae
- linea nigra( from xiphoid process to pubic symphisis)
abdominal exam in late pregnancy
palpation
increased fundal hehight
ovoid shape uterus
braxtonhicks
active fetal movment:
20WKS
palpation of fetal parts 20WKS
fundal height at 16 wks
betw/ pubic symphisis and umbilicus
fundal height at 22-24 wks (5-6mo)
umbilical level
fundal height at 28 wks (7mo)
between lower 1/3 and upper 2/3 of abdomen
fundal height at 32nd wk (8mo)
upper and mid 3rd of abdomen
fundal height at 36 wks (8-9mo)
at xiphoid cartilage
what is then accepted variation of fundal height
plus or minus 2 cm
what are braxton hicks contractions
painless tightening of the uterine muscles for 1-2 hrs preparing body for birth
No cervical changes
No rupture
what is the purpose of palpation of fetal parts in “dg of late pregnancy”
1) dg pregnancy in late stage
2) ID fetal position, lie and presentation
what is fetal lie
long axis of fetus in relation to long axis of mother
types of fetal lie
longitudinal
- fetal and mother lies are parralell (vertex or breach)
transverse
- fetal lie crosses mother’s lie vertically (shoulder)
what is fetal presentation
refers to the part of the fetus that first descends into the pelvis
head presentation
95%
breech presentatinon
3-5%
shoulder presentation
indication for US investigation in “dg of late
pregnancy”
check amniotic fluid volume
- oligoydromnious
- polyhydromnious
determine fetal number( mx gestation)
assertain fetal anatomy ( birth defects)
assertain integrity of cervical canal
fetal organ anatomy ( doppler for heart defects)
view placental anatomy
US fetal parameters in “dg of late
pregnancy”
HC: head circ
BPD: BIPARIETAL DIAMETER
AC: abdomincal circ
FL: femur length
BPD
values in “dg of late
pregnancy”
1st TM: greater than 3 cm
28th wk (7 mo): 7cm
32nd wk (8mo): 8cm increaseing 0.2 cm / wk
FL values in “dg of late
pregnancy”
2-3cm less than BPD
