L2: Sign of preg and care Flashcards
What is the length of the trimesters
1st: weeks 1-13
2nd: weeks 14-26
3rd: weeks 27- delivery
Each one is 3 months
what is antepartum?
time from conception to before birth. Also known as prenatal
What is intrapartum?
time during birth
When is baby considered term
37 to 41 weeks
when is baby post term
beyond 41 weeks + 3 days
Preterm is when a baby is
less than 37 wks
Define the following:
Gravidity
Parity
Gravida
Gravidity: pregnancy Parity: pregnancy lasting 20w or more Gravida: pregnant person Nulli- means none Multi- means 2 or more Primi- means 1
What are the presumptive (subjective) signs of pregnancy
- Amenorrhea
- fatigue
- nausea/vomitting
- breast and nipple changes
- increase peeing frequency
- quickening
What are the probable signs of pregnancy
- Goodell’s sign: softening of the cervix with edema and friability
- Chadwick’s sign: deepening of vaginal/cervix colour (bc of inc vascularization)
- Hegar’s sign: softening of the lower uterus. Cervix and the uterus seem to be two separate regions.
- Serum or urine hCG test. (false result is possible)
Home pregnancy test tests for what molecule?
hCG or beta-subunit of hCG
The first void of the day has less hCG in it
False: it has the most
What are the conclusive diagnoses of pregnancy?
- Ultrasound visualization of fetus
- Examiner feels quickening. Only after 20w of preg
- fetal heart detected via ultrasound doppler. Only possible after 8-12 wks
T or F: calculating ultrasound EDB during the first trimester is the most accurate method.
True
How do you calculate EDB from an ultrasound
Measurement of head to rump and head circumference
when are you able to see the fetus in an ultrasound
by 6wks
Uterine changes during pregnancy
Uterus changes from an upside down pear shape to an egg-like shape.
The fundus of the uterus can rise up to the xyphoid process. By 14 weeks it is palpable and by 20wks you can feel it at the umbilicus. Fundus height is measured from pubic symphysis to the fundus
What are Braxton hicks
Non/pre-labour contractions that start intermittently after the 4th month. They are mostly painless and go away with activity. The purpose is to inc blood flow to the uterus and fetus.
Explain the 5-1-2 rule
Labour contractions are at least 5 min apart, that last 1 minute for more than 2 hours.
What do we advise a patient to do when they are experiencing false contractions?
Relax, drink water, take a nice warm bath
How to tell if your pt’s contractions are true?
They increase in continue while increasing in frequency and intensity
What happens to the cervix close to labour?
The mucus plug that has formed to protect the amniotic sac will fall out. This can happen a couple of weeks before labour to during labour
What are some changes to the vulvar and vaginal regions
Edema, inc vascularity which leads to inc sensitivity, tissue loosens, more mucus (with acidic pH to protect from organisms).
Inc vascularity can lead to varicosities
What are some changes to breasts?
The changes are due to more progesterone and estrogen.
- hypertrophy of the Montgomery glands (sebaceous glands)
- More Erect nipple
Larger and darker areola
- More sensitive and tingly
- increased alveolar tissue and lactiferous glands (milk)
- May express colostrum within 16wks of gestation
What are some changes to the cardiovascular system
- Heart is shifted up and left
- s1 will sound louder
- decreased diastolic BP. Unchanged systolic BP.
- HR will inc by 10-15 beats
- Stroke volume will increase early on and then dec during late gestation
Inc BP, edema, protein in urine, headache, inc liver enzymes in blood work, changed vision during gestation are symptoms of ____
Preeclampsia
What is vena cava syndrome?
compressing the vena cava while lying supine. This will lower the blood return to the heart and can cause fetal hypoxia. The syndrome will inc as pregnancy progresses. During labour, we wedge a pillow on alternating sides of the back.
What can cause hemorrhoids during gestation
Hemorrhoids usually develop bc of inc pressure. This can occur during intrapartum esp while pushing. Some people are more genetically prone to hemorrhoids.
What changes happen to the hematologic system?
The blood volume increases by 1.5 L. 1L of plasma and 500mL of RBC. This happens to support the maternal vascular eyes and the fetus.
Inc clotting factors (fibrin and fibrinogen) to reduce bleeding. Problem is that it inc risk of thrombisis
What’s the usual cause of anemia in preg women?
Often the BV increases but there isn’t enough iron to make hemoglobin and so there is less RBC. Basically the blood is diluted (hemoglobin of 110 or less).
We prescribe Iron supplements
Describe the respiratory changes during preg
The mother’s chest expands as the diaphragm is pushed up. There is more vascularization that causes more nosebleeds. More mucus that causes congestion.
Physiological changes
- tidal volume inc and inspiratory capacity
- mother breaths harder and faster (inc RR)
- More O2 going in and out
Changes in the renal system
-There is more vascularization in the bladder
-The bladder is squished by the pelvic floor and the fetus.
There is more urine output in the kidneys but the urine flow is slow. This causes a risk for UTI (pyelonephritis )
- There is more frequency to pee without much amt.
- Thereis inc of nocturia bc of edema drainage
- Risk of occasional incontinence
What is a sista seal
Weak pelvic floor muscles cause the bladder or rectus to fall into the vagina. They can peak out of the vagina if severe. To prevent and treat sista seal physiotherapy for the pelvic floor is recommended
What is linea negra
Dark line longitudinal across the abdomen. Appears from preg hormones producing melanin. Goes away after preg
What is striae gravidarum
Stretch marks from separating connective tissue
Changes to the skin during preg
- inc perspiration
- Gum hypertrophy and inc vascularity
- Eye sensitivity bc of inc vasc
- inc nail growth
- pruritus (itching)
- Chloasma (preg mask): dark patched of skin
T or F Lordosis is a symptom of pregnancy
True
During pregnancy the rectus ____ muscles _____
- abdominus
2. seperate
What is restless leg syndrome
Leg cramps/antsy feeling in legs. No known cause but some believe it is due to low magnesium and other electrolytes.
How is carpal tunnel syndrome associated with pregnancy
Fluid retention during pregnancy compresses the median nerve.
GI changes during pregnancy
- Inc water retention in the colon > to constipation. Preventing constipation is important in the antepartum period.
- Taste and salivation inc
- ## Appetite decreases in 1st & 3rd trimester, but inc during the 2nd
- hGC: __
- Thyroid activity ___
- hPL ___
- progesterone and estrogen ___
- Increases to reduce mother immune response to the fetus
- increases with basal metabolic rate
- decreases insulin’s effectiveness
- inc to prevent early contractions. Causes many of the symptoms of pregnancy
How would a pregnant woman combat nausea and vomiting?
Eating frequent meals with lots of dry carbs. Stay hydrated
Is nausea a good sign related to pregnancy?
Yes. nausea is caused by increased estrogen and progesterone. So it’s a sign that the hormones are being produced
What is helpful for relieving nasal congestion in the first trimester?
a humidifier
What can help women with inc urinary frequency
Kegel exercise and voiding often
What can help with shortness of breath during pregnancy
- Rest with supporting pillows
- Do not eat heavy meals before sleep
- Good posture
Danger signs during pregnancy
- Heavy vaginal bleeding with sus symptoms (contractions, etc..)
- Severe headache and vision change: If not treated, preeclampsia will turn into eclampsia and pt will start having seizures.
- Chills and fever: infection
- Gush of vaginal fluid: could be a ruptured amniotic sac. Needs to be assessed. If labour is not induced within 24hrs, there is a significant rise in the risk of infection. If the fluid is coloured it could be meconium > maybe fetal distress. usually we induce labour within 12 hrs of the sac rupturing
