Maternal Adaptation During Pregnancy Flashcards by Brendon Allen

Antepartum
Intrapartum
Postpartum

Ante: prior to labor and childbirth

Intra: onset of labor thru delivery of placenta

Post: after birth until return of reproductive organs to normal nonpreg state (approx 6wks)

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Gestation
Abortion
Stillborn

Gestation: process of carrying embryo/fetus in uterus (pregnancy)

Abortion: loss prior to 20 wks gestation

Stillborn: fetal death at 20 wks or later

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Goal gestation
Preterm
Early term
Full term
Late term
Postterm

Goal: 37-42wks
Pre: <37wks (36/6wks)
Early: 37-38/6
Full: 39-40/6
Late: 41-41/6
Post: >42wks

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Gravida
Parity

Gravida: pregnancies

Parity: birth after 20 weeks

Twins only count as 1

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Nulligravida
Primigravida
Multigravida

Nulligravida: 0 prenancies
Primigravida: 1 or first
Multigravida: 2 or more

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Nullipara
Primipara
Multipara

Nullipara: 0 births after 20 wks
Primipara: 1 birth
Multipara: 2 or more

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TPAL

Term:37+ weeks

Preterm: 20-36/6wks

Abortion: loss prior to 20 wks

Living: # of living children

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Presumptive Signs of pregnancy
(Subjective-least indicative)

Amenorrhea: no period
N/V
Breast tenderness/changes
Fatigue
Reported wt gain
Increased urinary freq
Quickening

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Probable signs of pregnancy
(Objective)

Uterine changes: Heger sign (softening of lower uterine segment)

Cervical changes: chadwich(blue cervix), goodell signs (softening of cervix)

Positive preg test (serum/urine) HCG

Ballottement: pelvic exam, apply pressure to cervix and can feel something

Enlarged abdomen

Fetal outline felt by examiner (palpation)

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Positive signs of pregnancy

Fetal visualization (US)

Fetal heart tones

Fetal movement detexted/palpated by examiner

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Pregnancy test

HCG: human chorionic gonadotropin
(7-10 days after conception and as early as 7-8 days prior to expected menses)

Serum: high accuracy
Urine:
-use first voided moring urine
-if test done at time of missed period and neg, repeat the test 1 week if no period still
-f/u w/provider if pos or neg and still no period

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Uterus and ovaries changes

Ovulation and menses cease

12wks slightly above the symphysis pubis into the abdomen

Hegar sign: sofenting of lower uterine segment

Mcdonalds rule: fundal height (from pubis to uterus)
-level of umbilcus by approx 20 wks-1cm per week
-correlated to age= 32wks=32cm

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Uterus changes

Quickening- 16-20wks

Ballottement- 16-18wks

Braxton hicks- approx 20wks (false contractions)

Lightening- 38-40 wks
(Fundal height decreases as fetus descends into pelvis for birth)

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Cervix changes

Chadwicks sign: bluish color

Goodell sign: softening of cervix

Mucus plug

Increased friability (bleed easy)

Ripening: last 4 wks, softening, effacement

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Vagina changes

Ph: more alkaline
Risk of vaginitis

Glycogen rich:
Vulnerable to condidiasis(yeast)

Leukorrhea:
Increased white/grey vag discharge

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Breast changes

Enlargement: heaviness, fullness, tenderness

Nipple and areola become:
Large
Dark

Integumentary changes

Striae gravidarum: stretch markes
-breast, abdomen, buttocks, thighs

Chloasma: mask of pregnancy (hyperpigmentation)

Linea nigra: dark line from symphysis pubis to umbilicus

Cardiovascular changes
Blood volume

Increased blood volume:
-increase HR, systolic murmur, S3
-by 32 wks 10-15bpm increase

Little/no BP change
Maintain BP r/t vasodilation

Cardiovascular changes
Anemia and others

Pseudo-anemia d/t hemodilation (blood volume)
Hgb 12-16
Hct 38-47

Elevated clotting factors: hypercoagulable state
Vena cava syndrome: supine HOTN (shouldnt lay on back)

Respiratory changes

Oxygen demands increase
Increased RR

Third trim: larger uterus pushes diaphragm upward putting pressure on lungs

GI and Renal changes

GI:
N/V/Constipation
Heart burn
Food aversions or cravings
PICA

Renal:
Increased GFR
Increased frequency
Urine output stays the same

MSK changes

Relaxin
Increased mobility of pelvic joints may cause pain
Lordosis
Change in center of gravity/balance
Diastasis recti (abd split)

Endocrine/Metabolic changes

Increased BMR
Increased need of calories/protein/carbs/water

Placenta acts as an endocrine gland pruding:
HCG
Estrogen
Progesterone
Human placental lactogen

Wt gain expected

3.5-5lbs 1st semester (0-13 wks)

1lb per week (2nd and 3rd trimester)

Wt gain recommendations IOM Underweight Normal Overweight Obese

Underweight: 28-40lbs Normal: 25-35lbs Overweight: 15-25lbs Obese : 11-20lbs

Nutritional needs Energy/fluids

Energy: Additional 340kcal 2nd trimester 450kcal 3rd trimester Fluids: 8-10 glasses per day 4-6 glasses should be water

Nutritional needs Protein/calcium(examples of ca)

Protein: for growth Calcium: bone and teeth formation -milk -nuts -legumes -dark green leafy veggies

Nutritional needs Water soluble vitamines

Folic acid (folate): 400/600 mcg -fortified grains/cereals/breads -leafy veggies -dried peas/beans -seeds -OJ Pyridoxine (B6): helps w/ N/V Vitamin C (ascorbic acid): enhances iron absorption

Nutritional needs Iron

Best absorbed on empty stomach between meals Best when combined with/ vit C *milk, caffeine, and tea can inhibit absorption Fetal liver stores are from mom

Iron deficiency is associated with what

pre term birth LBW infants maternal/infant mortality

Iron animal sources

Red meats beef liver Fish poultry Dried peas/beans Fortified cereals/breads

Iron supplements can cause what Stools may look like what What does empty stomach cause Meds you can give

Cause green, tarry, thick bowel movements Empty stomach enhances absorption/ causes N/V Stool softeners

Nutritional issues in pregnancy

NO Alcohol Caffeine: No more than 200 mg daily Too much can cause: infetility spontaneous abortion IUGR (intrauterine growth restriction

Nutritional issues Fish & mercury levels Food to avoid

Avoid: Shark Swordfish Tuna King mackerel Tile fish

Nutritional issues in pregnancy Listeriosis: Avoid what foods

Listeriosis: Avoid: hot dogs lunch meat deli meat soft cheeses(brie/feta) meat spreads unpasterized milk/dairy

Nutrtional issues in pregnancy PICA Risks for it

PICA: ingestion or craving of nonfood substances w/ little or no nutritional value Risks: FH Childhood hx Low SES Iron/zinc deficiency (crave ice)