Maternal Adaptation During Pregnancy

Question 1

Antepartum
Intrapartum
Postpartum

Answer 1

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)

Question 2

Gestation
Abortion
Stillborn

Answer 2

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

Abortion: loss prior to 20 wks gestation

Stillborn: fetal death at 20 wks or later

Question 3

Goal gestation
Preterm
Early term
Full term
Late term
Postterm

Answer 3

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

Question 4

Gravida
Parity

Answer 4

Gravida: pregnancies

Parity: birth after 20 weeks

Twins only count as 1

Question 5

Nulligravida
Primigravida
Multigravida

Answer 5

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

Question 6

Nullipara
Primipara
Multipara

Answer 6

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

Question 7

TPAL

Answer 7

Term:37+ weeks

Preterm: 20-36/6wks

Abortion: loss prior to 20 wks

Living: # of living children

Question 8

Presumptive Signs of pregnancy
(Subjective-least indicative)

Answer 8

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

Question 9

Probable signs of pregnancy
(Objective)

Answer 9

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)

Question 10

Positive signs of pregnancy

Answer 10

Fetal visualization (US)

Fetal heart tones

Fetal movement detexted/palpated by examiner

Question 11

Pregnancy test

Answer 11

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

Question 12

Uterus and ovaries changes

Answer 12

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

Question 13

Uterus changes

Answer 13

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)

Question 14

Cervix changes

Answer 14

Chadwicks sign: bluish color

Goodell sign: softening of cervix

Mucus plug

Increased friability (bleed easy)

Ripening: last 4 wks, softening, effacement

Question 15

Vagina changes

Answer 15

Ph: more alkaline
Risk of vaginitis

Glycogen rich:
Vulnerable to condidiasis(yeast)

Leukorrhea:
Increased white/grey vag discharge

Question 16

Breast changes

Answer 16

Enlargement: heaviness, fullness, tenderness

Nipple and areola become:
Large
Dark

Question 17

Integumentary changes

Answer 17

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

Chloasma: mask of pregnancy (hyperpigmentation)

Linea nigra: dark line from symphysis pubis to umbilicus

Question 18

Cardiovascular changes
Blood volume

Answer 18

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

Little/no BP change
Maintain BP r/t vasodilation

Question 19

Cardiovascular changes
Anemia and others

Answer 19

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)

Question 20

Respiratory changes

Answer 20

Oxygen demands increase
Increased RR

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

Question 21

GI and Renal changes

Answer 21

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

Renal:
Increased GFR
Increased frequency
Urine output stays the same

Question 22

MSK changes

Answer 22

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

Question 23

Endocrine/Metabolic changes

Answer 23

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

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

Question 24

Wt gain expected

Answer 24

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

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

Question 25

Wt gain recommendations IOM
Underweight
Normal
Overweight
Obese

Answer 25

Underweight: 28-40lbs

Normal: 25-35lbs

Overweight: 15-25lbs

Obese : 11-20lbs

Question 26

Nutritional needs

Energy/fluids

Answer 26

Energy:
Additional 340kcal 2nd trimester
450kcal 3rd trimester

Fluids:
8-10 glasses per day
4-6 glasses should be water

Question 27

Nutritional needs

Protein/calcium(examples of ca)

Answer 27

Protein: for growth

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

Question 28

Nutritional needs

Water soluble vitamines

Answer 28

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

Question 29

Nutritional needs

Iron

Answer 29

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

Question 30

Iron deficiency is associated with what

Answer 30

pre term birth

LBW infants

maternal/infant mortality

Question 31

Iron animal sources

Answer 31

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

Question 32

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

Answer 32

Cause green, tarry, thick bowel movements

Empty stomach enhances absorption/ causes N/V

Stool softeners

Question 33

Nutritional issues in pregnancy

Answer 33

NO Alcohol

Caffeine:
No more than 200 mg daily

Too much can cause:
infetility
spontaneous abortion
IUGR (intrauterine growth restriction

Question 34

Nutritional issues

Fish & mercury levels
Food to avoid

Answer 34

Avoid:
Shark
Swordfish
Tuna
King mackerel
Tile fish

Question 35

Nutritional issues in pregnancy
Listeriosis:
Avoid what foods

Answer 35

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

Question 36

Nutrtional issues in pregnancy
PICA
Risks for it

Answer 36

PICA: ingestion or craving of nonfood substances w/ little or no nutritional value

Risks:
FH
Childhood hx
Low SES
Iron/zinc deficiency (crave ice)