MCN lecture: Antepartum (mother) Flashcards
Enumerate the signs and symptoms under “presumptive”
Period absent (amenorrhea) Really tired (fatigue) Enlarged breasts Sore breasts Urinary frequency increased Movement perceived (quickening) Emesis & nausea Drawings on body (linea nigra, striae gravidarum, melasma)
Enumerate the signs and symptoms under “probable”
Positive pregnancy test (high hCG levels)
Rebound of fetal presenting part (ballottement)
Objective
Braxton-Hicks contractions - painless practice contractions
A softening of the cervix (Goodell’s)
Bluish-purple discoloration of vulva, vagina, and cervix (Chadwick’s)
Lower uterine segment soft (Hegar’s)
Evidence (gestational sac on UTZ, fetal outline through Leopold’s); Enlarged uterus
Enumerate the signs and symptoms under “positive”
Fetal movement palpated Electronic device (Doppler) detects FHT The delivery of the baby Ultrasound detects fetal outline Seeing visible movements in ultrasound
What are the changes in the cardiovascular system that a pregnant woman undergoes? (7)
- Increased total blood volume
- Increased heart rate, cardiac output
- Cardiac deviation, slight cardiomegaly
- Blood pressure changes with positioning
- Increased total plasma volume
- Increased RBC, WBC count
- Hypercoagulable state
a. Total blood volume increases by how many percent?
b. Why does it increase?
a. 30-50%
b. To maintain 2 circulatory systems (mother and baby)
Recommended positioning for pregnant women to prevent supine hypotension syndrome
Left lateral position
Why does vasodilation occur in pregnant women?
To maintain blood pressure
a. Give the Hgb range for physiologic anemia.
b. Give the Hgb range for pathologic anemia.
c. Give the normal Hgb range for women.
a. 10.5 - 12 g/dL
b. < 10.5 g/dL
c. 12-16 g/dL
Dietary sources of iron
Green leafy vegetables
Dark meat
Organ meat
(the darker the food, the more iron content it has)
Why is it recommended to take iron supplements during the 2nd trimester?
RBC is increased, and iron is able to bind to them more effectively
In the third trimester, a pregnant woman’s WBC count may increase up to?
11,000-12,000/mm^3
What causes the pregnant woman’s hypercoagulable state?
Increased estrogen
What are the changes in the alimentary system that a pregnant woman undergoes? (4)
- Increased oral cavity pH
- Risk for gum bleeding
- Decreased GI motility
- Nausea and vomiting
What causes the decreased GI motility in pregnant women?
Progesterone (muscle relaxant)
Management for constipation (3)
- High fluid intake (3L/day)
- Exercise
- Stool softeners (e.g., Colace) as a last resort
Management for reflux due to big uterus (4)
- Upright position 30-60 mins after eating
- Small frequent feedings (6 smaller meals)
- Avoid fatty food since it is hard to digest
- Antacid (Maalox = safest)
Management for nausea and vomiting (3)
- Dry carbohydrates, ice chips
- Small frequent feedings
- Avoid aversions
What are the changes in the renal and urinary system that a pregnant woman undergoes? (4)
- Increased GFR
- Dilation of ureters
- Increased urinary frequency
- Vaginal pH becomes slightly more alkaline
Effect of increased GFR on sugar?
Sugar is filtered out better and shows up in the urine (does not necessarily mean gestational DM)
Cause of increased urination on:
a. 1st trimester?
b. 3rd trimester?
a. Increased cardiac output
b. Increased pressure on bladder by uterus
An alkaline vaginal pH may increase the risk of? (2)
Candidiasis, vaginal infection
What are the changes in the respiratory system that a pregnant woman undergoes? (3)
- Increased RR, tidal volume
- Shortness of breath due to diaphragm displacement
- Hyperemia, edema of nasal mucosa
What are the changes in the musculoskeletal system that a pregnant woman undergoes? (3)
- Lordosis
- Waddling gait
- Decreased total calcium
What hormone causes the waddling gait?
Relaxin
Dietary sources of calcium (2)
- Dairy products
- Fish
What are the changes in the cutaneous system that a pregnant woman undergoes? (3)
- Darkening of the skin
- Linea nigra
- Striae gravidarum
What is the difference between chloasma and melasma?
Chloasma - darkening of face
Melasma - darkening of other parts of the body
What are the changes in the peripheral vascularization of a pregnant woman? (2)
- Edema
- Varicosities
True or false: edema is normal in the lower extremities during pregnancy.
True; caused by pressure of gravid uterus
True or false: edema on face and upper extremities is normal during pregnancy.
False; may indicate pre-eclampsia
Pre-eclampsia indicators (3)
- Hypertension
- Proteinuria
- Edema
Areas where varicosities in pregnant women are common (3)
- Legs
- Rectum (in the form of hemorrhoids)
- Vagina
Weight gain of pregnant women:
a. in the first trimester?
b. in the 2nd and 3rd trimester?
c. What is the total weight gain of pregnant women?
a. 1 lb per month
b. 1 lb per week
c. 25-30 lbs