Maternal Adaptation During Pregnancy Flashcards
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)
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
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
Gravida
Parity
Gravida: pregnancies
Parity: birth after 20 weeks
Twins only count as 1
Nulligravida
Primigravida
Multigravida
Nulligravida: 0 prenancies
Primigravida: 1 or first
Multigravida: 2 or more
Nullipara
Primipara
Multipara
Nullipara: 0 births after 20 wks
Primipara: 1 birth
Multipara: 2 or more
TPAL
Term:37+ weeks
Preterm: 20-36/6wks
Abortion: loss prior to 20 wks
Living: # of living children
Presumptive Signs of pregnancy
(Subjective-least indicative)
Amenorrhea: no period
N/V
Breast tenderness/changes
Fatigue
Reported wt gain
Increased urinary freq
Quickening
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)
Positive signs of pregnancy
Fetal visualization (US)
Fetal heart tones
Fetal movement detexted/palpated by examiner
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
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
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)
Cervix changes
Chadwicks sign: bluish color
Goodell sign: softening of cervix
Mucus plug
Increased friability (bleed easy)
Ripening: last 4 wks, softening, effacement
Vagina changes
Ph: more alkaline
Risk of vaginitis
Glycogen rich:
Vulnerable to condidiasis(yeast)
Leukorrhea:
Increased white/grey vag discharge
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)
