Diagnosis of Pregnancy/Prenatal Care & Nutrition Flashcards
(199 cards)
1
Q
Diagnosis of Pregnancy is divided into 3 evidences:
A
- Presumptive Evidence of Pregnancy
- Probable Evidence of Pregnancy
- Positive Signs of Pregnancy
2
Q
PRESUMPTIVE EVIDENCE OF PREGNANCY (SYMPTOMS)
A
- Nausea with or without vomiting
- Disturbances in urination
- Fatigue
- Perception of fetal movement
- Breast symptoms
3
Q
Peculiar distaste for food, food idiosyncrasies, and other digestive tract disturbances during ________ of pregnancy.
A
first 2-3 months of pregnancy
4
Q
Sometimes the food that she likes when she was still not pregnant, doesn’t like it anymore when in pregnancy period.
A
Peculiar distaste for food
5
Q
She looks for foods like fruits that is not in season.
A
Food idiosyncrasies
6
Q
→ Usually vomits every morning.
o Other patients also vomit in the afternoon and in evening.
A
Morning sickness
7
Q
Extreme cases of nausea with or without vomiting are associated with _________.
A
hyperplacentosis as in multiple and molar pregnancies
8
Q
It is when the nausea and vomiting is really extensive or extreme
A
Hyperemesis gravidarum
9
Q
Hyperemesis gravidarum usually appears at _______ AOG, reaches its peak at about ________ and disappears thereafter.
A
6 weeks AOG, reaches its peak at about 60-70 days and disappears thereafter
10
Q
Management for nausea & vomiting
A
- Frequent small feedings
- Avoidance of fatty foods
- Light, dry, low fat diet
- Ice chips
- Emotional support from husband and family
- Hydration and correction of fluids and electrolytes
11
Q
DISTURBANCES IN URINATION is caused by?
A
Caused by direct pressure of the enlarging uterus to the urinary bladder resulting in irritability, dribbling, frequency and UTI.
12
Q
Most of these patients are prone to develop UTI because of the shift of vaginal pH from _____ to _______.
A
from acidic to basic
13
Q
FATIGUE is attributed to?
A
Attributed to the increased metabolism during pregnancy
14
Q
Brisk movement in the patient’s abdomen
A
Quickening
15
Q
PERCEPTION OF FETAL MOVEMENT is just a presumptive symptoms of pregnancy because?
A
not all patient will experience this type of fetal movement
16
Q
Quickening occurs at around?
A
Around 18th-20th week (Primigravida); 14th-16th weeks (Multigravida)
17
Q
May be mistaken for peristalsis or spasm of the GIT.
A
Quickening
18
Q
Breast tenderness
A
Mastodynia
19
Q
Mastodynia occurs during?
A
during the first few weeks of gestation
20
Q
Mastodynia is brought about by the effects of what hormone/s?
A
Brought about by the effects of ESTROGEN which stimulate the mammary duct system; and by PROGESTERONE which stimulate the alveolar components.
21
Q
Mastodynia is also a presumptive symptoms of pregnancy because during the time that patients who are going to menstruate, they also develop breast tenderness because of the increased in the level of _______ just before you menstruate.
A
progesterone
22
Q
PRESUMPTIVE EVIDENCE OF PREGNANCY (SIGNS)
A
- Cessation of menstruation
- Anatomical breast changes
- Changes in the vaginal mucosa
- Skin pigmentation changes
- Thermal signs
23
Q
One of the earliest sign of pregnancy.
A
CESSATION OF MENSTRUATION
24
Q
Delay of menstruation is usually _______.
A
10 days or more
25
Cessation of menstruation is not a reliable indicator as delays may be caused by several emotional factors like:
1. Emotional Stress
2. Irregular menstrual cycle
3. Chronic disease
4. Drugs/Medication
5. Endocrine disorders
6. Lactation
7. Certain genitourinary tumors
26
This is the bleeding on the first 4 weeks after you have a positive serum pregnancy test.
Implantation bleeding
27
In cases wherein you are about to menstruate or during the early part of pregnancy there will be breast engorgement because of the increased level of?
estrogen
28
Anatomical breast changes happens when?
Happens about 6-8 weeks after conception
29
Colostrum can be expressed as early as ______ AOG.
16 weeks
30
The vaginal mucosa becomes congested and violaceous, bluish and purplish in color.
Chadwick’s sign
31
Chadwick’s sign appears at?
at about 6 weeks AOG
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Refers to darkening of the skin over the forehead, bridge of the nose and cheekbones.
CHLOASMA or mask of pregnancy
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Refers to darkening of the linea alba secondary to stimulation of the melanophores by the melanocyte stimulating hormone.
LINEA NIGRA
34
LINEA NIGRA includes the darkening of what body parts?
1. nipple
2. areola
3. lower midline of the abdomen
4. axilla
5. neck
6. groin
35
These are caused by the separation of the underlying collagen tissue and appear as dark, irregular scars in the abdomen.
STRIAE GRAVIDARUM or stretch marks
36
When the patient had already delivered, the stretch marks will appear as a silvery scars and they also become discolored after ______ weeks of puerperium period.
4-6 weeks
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Are vascular, stellate marks which result from high levels of circulating estrogen and which blanch when compressed;
SPIDER TELANGIECTASIA
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Associated sign together with spider telangiectasia
palmar erythema
39
Thermal signs are perceptible elevation of temperature longer than?
3 weeks
40
Thermal signs are attributed to the thermogenic effect of?
progesterone
41
PROBABLE EVIDENCE OF PREGNANCY
1. Enlargement of the abdomen
2. Changes in the size, shape, consistency of the uterus
3. Anatomical changes in the cervix
4. Braxton-Hicks contractions
5. Ballottement
6. Physical outlining of the fetus
7. Positive results of endocrine tests
42
ABDOMINAL ENLARGEMENT is observed at?
Observed from 6 weeks onwards to near term.
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At 12th week, the fundus is at the level of?
symphysis pubis
44
Rapid fetal growth as the uterus rises out of the pelvis and into the abdomen.
16-22 weeks
45
AOG equals the fundic height
16-32 weeks
46
Is the softening of the uterine isthmus which is often observed by 6-8 weeks AOG.
HEGAR’S SIGN
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Refers to cyanosis and softening of the cervix due to increased vascularity of the cervical tissue which occurs as early as 4 weeks.
GOODELL’S SIGN
48
Softening of the cervix occurs at?
6-8 weeks
49
Cervical mucus during pregnancy has a characteristic BEADED cellular pattern which characterizes the ________ effect on normal cervical mucus;
PROGESTATIONAL
50
FERNING pattern is _______ predominance seen on the first half of the cycle.
ESTROGEN
51
Evidence of ovulation period.
Ferning Pattern
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Are painless irregular contractions which may be both palpable and visible as pregnancy progresses.
BRAXTON HICKS CONTRACTIONS
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These contractions can be secondary to the contraction brought about by fetal movement or can be secondary to the hyperirritability of gastrointestinal tract.
BRAXTON HICKS CONTRACTIONS
54
BRAXTON HICKS CONTRACTIONS can be perceived when?
Can be perceived from 28 weeks onwards.
55
Bouncing back of the presenting part on the examining finger
BALLOTTEMENT
56
When doing the Leopold’s maneuver, the baby usually moves inside the uterus causing the examining finger to bounce back.
BALLOTTEMENT
57
OUTLINING OF THE FETUS dfferential diagnosis:
Myomas or ovarian new growths
58
hCG can be detected in the serum or urine as early as ______ days after ovulation.
8-9 days
59
POSITIVE SIGNS OF PREGNANCY
1. Identification of fetal heart action separately and distinctly from the mother.
2. Perception of active fetal movement by the examiner.
3. Recognition of the embryo or fetus by ultrasound or by radiological methods.
60
Fetal heart tone (FHT) is faster than the mother’s heart beat ranging from _____ bpm
120-160 bpm
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When can the FHT be heard through the stethoscope?
18th week
62
Fetal echocardiography and ultrasound can demonstrate FHT at?
10th-12th week
| 6-8 weeks
63
Maternal conditions that increase fetal heart tones more than 1 per minute.
1. Fever
2. drugs (tocolytic)
3. thyrotoxicosis
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soft blowing sound heard in Doppler
Funic soufflé or umbilical cord soufflé
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Soft blowing sound under Doppler or the stethoscope and sometimes synchronous with maternal pulse,
Uterine soufflé
66
Uterine soufflé is heard when?
Usually heard in second trimester
67
Can be appreciated when examining the patient on same side
Maternal pulse
68
Other sounds that can be heard thru the abdominal wall other than the FHT:
1. Funic soufflé or umbilical cord soufflé
2. Uterine soufflé
3. Sound from movement of fetus
4. Maternal pulse
5. Gurgling gas in mother’s GIT
69
PERCEPTION OF FETAL MOVEMENT BY THE EXAMINER is usually perceived when?
Usually perceived by the 20th week
70
RECOGNITION OF FETUS OR EMBRYO BY ULTRASOUND is appreciated when?
6-12 weeks
71
the crown rump length (CRL) measurement is predictive of gestational age at?
6-12 weeks
72
At 6-12 weeks, the crown rump length (CRL) measurement is predictive of gestational age and is accurate within?
4 days
73
Other information verified by the ultrasound:
1. Presence of blighted ovum
2. Number of fetuses
3. Ectopic gestation
4. Presenting part
5. Fetal anomalies
6. Hydramnios
7. Detection of IUGR
74
As early as _______ weeks, most of these babies are in breech presentation and then the sonologist will tell you or recommend that we have to do a repeat ultrasound near term so that we will know what really is the cephalic or not.
20-28th weeks
75
You have to request an ultrasound for congenital screening as early as _____ weeks. That is the best time to request for a congenital anomaly screening especially if the patient is exposed to chemicals or underwent X-ray and if the mother is already in the elderly age.
18-22 weeks
76
The amount of fluid inside the uterine cavity
Hydramnios
77
Imaginary or spurious pregnancy
PSEUDOCYESIS
78
Used as confirmatory for pseudocyesis.
Pelvic ultrasound is used for confirmatory.
79
IDENTIFICATION OF FETAL LIFE OR DEATH is confirmed by?
ultrasound
80
Signs and symptoms of Fetal Death
1. Uterine size has remained the same or has decreased
2. Cessation of fetal movement
3. Hyperemesis is not there anymore
4. Normal blood pressure in hypertensives
5. Loss of breast engorgement
6. Decrease in maternal weight
7. Soft collapsible skull felt on IE
8. Absent FHT by Doppler or stethoscope
9. Tobacco-stained amniotic fluid
81
RADIOGRAPHIC EVIDENCE TO ESTABLISH THE DIAGBNOSIS OF FDU (FETAL DEATH-IN-UTERO)
1. SPALDING’S SIGN
2. Exaggeration of fetal spine curvature.
3. ROBERT’S SIGN
82
Significant overlapping of the skull bones
SPALDING’S SIGN
83
Demonstration of gas bubbles in the fetus.
ROBERT’S SIGN
84
Is a planned program of medical evaluation and management, observation and education of the pregnant women directed toward making pregnancy, labor, delivery, and the postpartum recovery a safe and satisfying experience.
PRENATAL CARE
85
is a woman who has been delivered only once of a fetus or fetuses which reached viability.
PRIMIPARA
86
is a woman who has completed 2 or more pregnancies to viability.
MULTIPARA
87
is a woman who is not now and never has been pregnant.
NULLIGRAVIDA
88
is a woman who is or has been pregnant irrespective of the pregnancy outcome.
GRAVIDA
89
pertains to pregnancy
GRAVIDA
90
means that the patient has already delivered.
PARA
91
woman of her first pregnancy.
PRIMIGRAVIDA
92
multiple pregnancies.
MULTIGRAVIDA
93
is a woman who has never completed a pregnancy beyond the stage of viability or beyond and abortion.
NULLIPARA
94
is a woman in labor.
PATURIENT
95
is a woman who had just given birth.
PUERPERA
96
period within 6 weeks after delivery
PUERPERIUM
97
G
number of pregnancies
Even if the pregnancy has not reached viability, as long as the pregnancy test is positive it is already to be counted.
98
P
number of deliveries
99
1st 0
number of full-term deliveries
100
2nd 0
number of preterm deliveries
101
3rd 0
number of abortions or miscarriages including H-mole and ectopic pregnancies
102
4th 0
number of living children
103
currently pregnant woman
G1P0 (0000)
104
woman who delivered with her 1 child in full term
G1P1 (1001)
105
woman who delivered preterm
G1P1 (0101)
106
woman who had an abortion/1st miscarriage
G1P0 (0010)
107
the child died at full term
G1P1 (1000)
108
twin pregnancy at full term
G1P1 (2002)
109
twin pregnancy that is preterm
G1P1 (0202)
110
twin pregnancy and end up in abortion
G1P0 (0020)
111
ectopic/miscarriage/abortion
G1P0 (0010)
112
Is a method of estimating the date of confinement
NAEGELE’S RULE
113
NAEGELE’S RULE formula
From the 1st day of the last menstrual period, add 7 days, then subtract 3 months and add 1 year.
(-3/ +7/ +1)
114
TIMING FROM OVULATION
Add 267 days from the woman’s date of last ovulation. This is only true for women with 28-day cycle.
115
maternal perception of fetal movement is perceived initially at _____ weeks in multigravidas and ________ weeks in primigravidas.
16-18 weeks in multigravidas and 18-20 weeks in primigravidas.
116
12 weeks
at level of symphysis pubis
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16 weeks
halfway between umbilicus and symphysis pubis
118
20 weeks
at level of umbilicus
119
36 weeks
is below the ensiform cartilage
120
Transvaginal ultrasound can detect a pregnancy at 4-5 weeks’ gestation corresponding to the serum B-hCG concentration of _______ miu/ml.
1500-2000miu/ml.
121
Transvaginal ultrasound is used during early pregnancy because?
Transvaginal ultrasound is used during early pregnancy because the transducer of the ultrasound has direct contact with the cervix giving accurate crown rump length and AOG.
122
1 trimester is equal to how many weeks?
13 weeks
123
What age of patients are labeled as highly threatened/high risk?
<20 and >40 years old
124
Leopold’s maneuver is best done when?
on the 20th week age of gestation. Earlier than that, you cannot appreciate Leopold's maneuver.
125
2 gloved and lubricated fingers are inserted into the vagina while the other hand gently compresses the lower abdomen to check the size, shape and position of the uterus.
Bimanual examination
126
ROUTINE ANTEPARTAL TESTS
1. CBC, blood typing, Rh typing
2. Urinalysis, urine culture and sensitivity
3. Serologic test for syphilis (RPR, VDRL)
4. Hepatitis B surface antigen
5. Rubella titer
6. Cervical cytology (Pap smear)
127
PRENATAL INTRUCTIONS
1. Inform the patient of any problems and discuss management.
2. Antepartum education program.
3. Explain future visits
4. Discuss the economic aspect of pregnancy
5. Give instruction about diet, relaxation and sleep, bowel habits, exercise, bathing, taking recreation, sexual intercourse, smoking, drug and alcohol ingestion.
6. Emphasize danger signals such as vaginal bleeding, persistent vomiting, chills and fever, sudden escape of fluid from vagina, abdominal pain, swelling of face, blurring of vision, and continuous headache.
128
FREQUENCY OF VISITS:
| 0-28 weeks
every 4 weeks
129
FREQUENCY OF VISITS:
| 28-36 weeks
every 2 weeks
130
FREQUENCY OF VISITS:
| 36-40 weeks
every week
131
internal exam, check if cervix is dilated
38 weeks
132
request for RT-PCR testing if mother will deliver in the hospital, because they can get it for free in any molecular laboratories in Iloilo as long as they have a PhilHealth.
37 weeks
133
WHO recommendation # of visits
4 visits or more
134
maternal serum alpha feto-protein screening
15-20 weeks
135
gestational diabetes screening
24-28 weeks
136
test D-negative women for antibodies
28 weeks
137
In L1, L2, and L3 – you are facing the mother ______.
cephalad
138
FUNDAL GRIP
L1
139
While facing the woman, palpate the woman’s upper abdomen with both hands.
L1
140
To know what part of baby occupies the fundus
L1
141
The fetal _____ is hard, round, and moves independently of the trunk
head
142
_______ feel softer, are symmetric, and the shoulders and limbs have small bony processes; unlike the head, they move with the trunk.
buttocks
143
UMBILICAL GRIP
L2
144
Both the examiner’s hand is on the side
L2
145
To determine the location of the fetal back
L2
146
While facing the patient, the examiner palpates the abdomen with gentle but also deep pressure using the palm of the hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman’s uterus. This is then repeated using the opposite side and hands.
L2
147
The fetal ______ will feel firm and smooth while fetal extremities should feel like small irregularities and protrusions or nodulations.
back
148
PAWLICK’S GRIP
L3
149
To determine what fetal part is lying above the inlet, or lower abdomen.
L3
150
To know if the presenting part is engaged or still floating.
L3
151
Grasps the lower portion of the abdomen just above the pubic symphysis with the thumb and fingers of the right hand.
L3
152
PELVIC GRIP
L4
153
To locate the fetus’ brow
L4
154
The fingers of both hands are moved gently down the sides of the uterus toward the pubis.
L4
155
The side where there is resistance to the descent of the fingers toward the pubis is greatest is where the ______ is located.
brow
156
If the fetal head is extended though, the _____ is instead felt and is located on the same side of the back.
occiput
157
MATERNAL EVALUATION
1. Blood pressure, actual and extent of change.
2. Weight, actual and amount of change.
3. Symptoms: headache, nausea, vomiting, bleeding, dysuria, bleeding from vagina.
4. Fundic height
5. Leopold’s maneuver
6. Vaginal examination at first visit and at term
158
FETAL EVALUATION
1. Fetal heart rate
2. Size of fetus, actual and rate of change (through fundic height)
3. Presenting part and station
4. Fetal activity
159
CBC
Should be repeated at 28-32 weeks.
160
Serum alpha feto-protein
16-18 weeks (for neural tube defects)
161
Screening for glucose intolerance
24-28 weeks
162
HBsAg
last trimester
163
RT-PCR test
for COVID 19 at 37 weeks
164
recommended weight gain during the entire pregnancy.
10-12 kg
165
CALORIES:
| Should have additional _______ kcal/day be allowed during the 2nd and 3rd trimester.
300 kcal/day
166
PROTEIN:
| Recommended ____ grams/day during the entire pregnancy
9 grams/day
167
Are the main source of energy during pregnancy
CARBOHYDRATES
168
Account for an average of 74% of total energy intake
CARBOHYDRATES
169
CARBOHYDRATES:
| Recommended intake is _____ grams/day.
150-225 grams/day
170
Are the most concentrated sources of energy
FATS
171
Adds palatability and satiety value to diet; are sparer’s of proteins
FATS
172
FATS:
| Daily minimum intake should be _____ grams.
15-25 grams
173
Promotes normal bowel functions
DIETARY FIBER
174
CALCIUM:
| Recommended intake is _____ mg/dl.
900 mg/dl
175
for lactose intolerance, take ________.
500mg tablet twice per day
176
Essential for the calcification of bones and teeth.
PHOSPHORUS
177
Increased need is during the 2nd and 3rd trimester.
IRON
178
Average requirement of Iron is ___ mg/dl for the whole duration of pregnancy.
41 mg/dl
179
2nd most abundant trace element in the body.
ZINC
180
Essential for the activity of most enzymes.
ZINC
181
Is required for normal growth and sexual maturation, brain development and function, and immune function.
ZINC
182
Recommended intake of Zinc is ___ mg/dl.
12 mg/dl
183
Recommended intake of Iodine is _____ ug/dl.
125 ug/dl.
184
Deficiency leads to megaloblastic anemia
FOLATE or FOLIC ACID
185
Folic acid recommendation is _____ ug/dl
350 ug/dl
186
Is required for vision, growth, cellular differentiation and proliferation reproduction and integrity of the immune system.
VITAMIN A
187
Recommendation of Vitamin A is ______ RE (retinol equivalent).
475 RE (retinol equivalent)
188
Also known as aneuria or antineuretic factor.
VITAMIN B1 or THIAMINE
189
Recommended daily allowance of Vitamin B1 is _____ mg/dl.
1.3 mg/dl.
190
Most important because it alleviates the nausea and vomiting during the 1st trimester.
VITAMIN B2 or RIBOFLAVIN
191
Exerts an important controlling influence on body influences.
VITAMIN B2 or RIBOFLAVIN
192
Signs of Riboflavin deficiency:
Angular Stomatitis, Glossitis, Cheilosis, and Seborrheic dermatitis.
193
RDA of Vitamin B2 is _____ mg/dl.
0.6 to 1 mg/dl
194
RDA of Vitamin B6 (Pyridoxine) is ___ mg/dl
2 mg/dl
195
Occurs naturally only in foods of animal origin
VITAMIN B12
196
RDA of Vitamin C is ___ mg/day
70 mg/day
197
Pregnant women can travel up to ___ weeks AOG.
34 weeks
198
COMMON COMPLAINTS DURING PREGNANCY
1. Nausea and vomiting
2. Back pain
3. Varicosities
4. Hemorrhoids
5. Heartburn
6. Pica
7. Ptyalism
8. Fatigue
9. Headache
199
Leukorrhea
→ Trichomonas vaginalis
→ Monilia
→ Gardnerella
