Exam 2: A&P of Pregnancy

Question 1

Biochemical Marker for pregnancy

Answer 1

Human chorionic gonadotropin (hCG)

Question 2

Trimesters of pregnancy

Answer 2

First trimester: weeks 1-13
Second trimester: Weeks 14-26
Third Trimester: Weeks 27-40

Question 3

Obstetrical History

Answer 3

GTPAL

Question 4

Signs of Pregnancy

Answer 4

-Presumptive-changes felt by the woman.
-Probable-changes observed by an examiner
-Positive- signs attributed only to the presence of a fetus

Question 5

Presumptive Signs of Pregnancy

Answer 5

-Those that suggest but do not positively indicate pregnancy.
-Changes felt by woman
-breast changes
-amenorrhea
-Nausea and vomiting
-urinary frequency
-fatigue

Question 6

Probable Signs of Pregnancy

Answer 6

-Strong indicators of pregnancy.
-Positive pregnancy test.
-changes observed by examiner
-Mainly physical changes in uterus
-Hegar Sign: softening and compressibility of lower uterine segment.
-Ballottement: Passive movement of the unengaged fetus.
-Goodell sign: softening of the cervical tip
-Chadwick sign: deepening color of vagina

Question 7

Positve Signs

Answer 7

-Absolute confirmation of pregnancy
-Attributed by the presence of the fetus
-Fetal Heart tones
-Palpation of fetal movement
-Visualization of fetal movement

Question 8

Uterus changes with pregnancy

Answer 8

-changes in size, shape, and position
-stimulated by high levels of progesterone & estrogen
-fundal height measured to estimate the duration of pregnancy.
-Lightening: b/t wks 38-40 fundal height decreases as the fetus begins to descent and engage in pelvis.

Question 9

Fundal Height

Answer 9

-Fundal height measured to estimate the duration of pregnancy.
-Should equal the gestational age.

Question 10

Uteroplacental Blood Flow

Answer 10

-Dependent on mother
-increases and uterus grows

Question 11

cervix and vagina

Answer 11

-Goodell Sign & Chadwick Sign
-Leukorrhea-white or slight gray mucoid discharge with a musty odor.
-Operculum: mucus that fills the endocervical canal resulting in formation of mucus plug.

Question 12

breast changes

Answer 12

-increased sensitivity, tingling, & heaviness
-nipples and areolae become pigmented
-Montgomery’s tubercules- hypertrophy of the sebaceous glands may be seen
-Blood Vessels more noticeable
-colostrum as early as 16 weeks

Question 13

cardiovascular changes

Answer 13

-hypertrophy possible
-heart pushed to the left and upward
-Blood Volume increased
-Murmurs common
-increased pulse

Question 14

CV System

Answer 14

-BV inc. 30-50%
-HR inc by 10-15 bpm
-clotting factors inc. which helps prevent hemorrhage however increases risk of DVT
-RBC mass increases (plasma portion faster..physiological anemia)
-BP unchanged d/t progesterone.
500-1000 mL of blood to uterus per minute
-supine hypotension a major problem
-Hgb < 11g/dL indicates anemia

Question 15

Blood Pressure changes

Answer 15

-affected by age, activity level, presence of health problems.
-BP lowest on left lateral side
-compression of vena cava when woman lies flat.
-supine hypotension syndrome: resulting in woman feeling faint

Question 16

Blood Volume/composition changes

Answer 16

-Increases by 1500 ml or 40-45% above non-pregnant state
-Physiologic anemia common
-WBCs increase
-Increased clotting factors leads to
vulnerability for thrombosis

Question 17

Tendency of thrombosis

Answer 17

-Avoid sitting for long periods of time
-Change positions frequently
-Elastic stockings
-Anticoagulation therapy

Question 18

Respiratory System Change

Answer 18

-O2 needs increase due to acceleration of
metabolic rate; increases by about 20%
-Ligaments of rib cage relax due to increased estrogen levels; rib cage
widens
-Elevated diaphragm and chest wall lead
to dyspnea
-Nosebleeds and nasal stuffiness are common and related to estrogen

Question 19

Renal system changes

Answer 19

-Frequent urination is common,
particularly in the first and third
trimesters
-In the first trimester due to bladder
sensitivity
-Predisposition to urinary tract infection
(UTI)

Question 20

Urinary System Changes

Answer 20

-Nocturia
-Kidneys working 50% harder (GFR)
-Increased renal plasma flow
-Proteinuria may occur and
is abnormal.

Question 21

Integumentary System Changes

Answer 21

-Chloasma-pregnancy mask
-Linea nigra- pigment line from top of fundus to symphysis pubis
-Striae gravidarum- stretch marks-last past pregnancy
-Vascular spiders-raised, pulsating end
arterioles found on neck, thorax, face, &
arms
-Palmar erythema-red blotches on hands
-Pruritus- pregnancy rash

Question 22

Musculoskeletal System

Answer 22

-Alteration in posture-Lordosis
-Center of gravity shifts
-Waddling
-Relaxation & increased mobility of
pelvic joints
-Abdominal muscles stretch and lose tone

Question 23

Neurologic Changes

Answer 23

-Carpal tunnel syndrome
-Tension head aches
-Lightheadedness
-Hypocalcemia-may cause
neuromuscular problems such as muscle
cramps & tetany

Question 24

GI system

Answer 24

Gums appear red and swollen and bleed easier, caused by elevated levels of estrogen (soft toothbrush)
-Delayed gastric emptying and reduced tone of esophageal sphincter allows reflux, producing heartburn. Caused by progesterone
-Decreased motility in large intestine causes constipation and hemorrhoids
-Gallbladder emptying time prolonged—may lead to stone formation

Question 25

Hyperemesis Gravidarum

Answer 25

• severe case of morning sickness
  -Zofran
  -IV therapy to correct fluid and electrolyte imbalances

Question 26

Endocrine System

Answer 26

-Basic metabolic rate (BMR) increases 25%
-O2 consumption increases
-Heat intolerance due to vasodilatation, fetal and maternal heat production

Question 27

Endocrine

Answer 27

-Pituitary/placental hormones-elevated
-levels of estrogen & progesterone
produced by corpus luteum in ovary
until 14 weeks of gestation; then
placenta suppress secretion of FSH &
LH by anterior pituitary

Question 28

Placental Hormones

Answer 28

1)Estrogen: Increases vascularity. Level remains high during pregnancy
2)Progesterone: Relaxes all smooth muscle. Maintains the endometrium and prevents abortion by relaxing uterine muscles
3)Human Chorionic Gonadotropin (hCG): Hormone: measured in pregnancy tests. Stimulates the corpus luteum to produce estrogen and progesterone until
the placenta can assume that function
4)Relaxin: Softens connective tissue and relaxes pelvic joints

Question 29

Warning Signs

Answer 29

-Educate to contact HCP
-Bleeding in pregnancy
-Decreased fetal movement/alteration in the pattern of fetal movement
-Leaking Fluid

Question 30

Office visits Assessments

Answer 30

-FHT
-Vital Signs
-Check Urine
-Weight
-Fetal Movement
-Fundal Height
-Education

Question 31

Prenatal Lab/Testing

Answer 31

-CBC
-Serology/VDRL (tests for syphilis)
-STD screening (Chlamydia,
gonorrhea, herpes)
-Pap smear (cervical cancer screening)
-Antibody titers for rubella and Hepatitis B
-ABO/Rh typing
-Plasma glucose
-Urinalysis
-TB screening
-TORCH screening
-Alpha-fetoprotein (AFP)
-Group B Beta Strep
-HIV

Question 32

Domestic Violence

Answer 32

-Pregnant women more abused than general population
-Most likely related to the partner feeling a sense of lack of control/power
-Essential to screen throughout the entire
pregnancy
* Important to ASK the questions:
1) “In your current relationship, do you feel safe?”
2) “Within the last 6 months have you been hit, slapped, kicked, or punched?”
3) “Do you fear for your own safety or the safety of your children?”

Question 33

Substance Abuse

Answer 33

Alcohol
* Tobacco
* Marijuana
* Cocaine
* Amphetamines
* Heroin
* Other prescribed or ilicit drugs

Question 34

Return Visits

Answer 34

-Every month from 4 to 28th weeks
-Gestational diabetes screen between 24
to 28 weeks
-Every 2 weeks from 28 to 36 weeks
-Every week from 36 weeks to delivery
-PP visit at 6 weeks or earlier