Mod 1 Flashcards
Define Gravida.
Any pregnancy regardless of duration including in the present pregnancy.
Definitely Nulligravida.
A woman who has never been pregnant.
Define Primigravida.
It woman who is pregnant for the first time.
Define Multigravida.
A woman who is in her second or any subsequent pregnancy.
Define Para.
Birth after 20 weeks gestation regardless if infant is born dead or alive.
Define Nullipara.
A woman who has had no birth at more than 20 weeks gestation.
Define Primipara.
It woman who has had one birth at more than 20 weeks gestation weather dead or alive.
Define Multipara.
A woman who has had two or more births at more than 20 weeks gestation.
Define stillbirth.
An infant born dead after 20 weeks gestation.
In the obstetrical history what do the letters G and P stand for?
G= gravida (# of pregnancies including current) P= para (birth after 20 weeks weather dead or alive)
In the obstetrical history what does the letter T stand for in TPAL?
T= The number of term infants born between 38 and 42 weeks gestation.
In the obstetrical history what dose the letter P stand for in the TPAL?
P= The number of preterm infants born after 20 weeks but before completing 37 weeks.
In the obstetrical history what does the letter A stand for in TPAL?
A= The number of pregnancies ending in spontaneous or therapeutic abortion (less than 20 weeks)
In the obstetrical history what does the letter L stand for in TPAL?
L= The number of currently living children
What does the TPAL assessment do for the GP assessment?
It further defines the GP assessment and gives a more complete obstetric history.
In relation to the GP assessment, are twins, triplets, quadruplets, etc. considered one birth or multiple births?
They are considered to be one para (birth).
Mary is pregnant for the fourth time she has had one abortion at eight weeks, she has a daughter born at 40 weeks, and a son at 34 weeks. What is her obstetrical history?
G4 P2
T1 P1 A1 L2
A 28-year-old woman is pregnant currently and has a history of delivering term twins followed by a spontaneous abortion what is her GP and TPAL?
G3 P1 (G3 because you count present pregnancy, one twin pregnancy, and one abortion. P1 because she only had one delivery even if they were twins.) TPAL- 2012
Traci is pregnant for the fourth time. At home she has a child who was born term. Her second pregnancy ended at 10 weeks gestation. She then gave birth to twins at 35 weeks and one of the twins died soon after birth. What is her OB history?
G4 P2
TPAL - 1212
In relation to the expected birthdate of the baby what does the abbreviation EDB stand for?
Estimated date of birth
In relation to the birthdate of the baby what does the abbreviation EDD stand for?
Estimated date of delivery
In relation to the birthdate of the baby what does the abbreviation EDC stand for?
Estimated date of confinement, or when the patient is supposed to go to the hospital.
What does the abbreviation LMP stand for?
Last menstrual period, (the first day when the menstrual period happened not the day that it ended!)
What is Naegele’s rule?
To calculate the due date, count back three months from the last menstrual period and add seven days and one year.
Example:
LMP: October 10, 2016
EDC: July 17, 2017
How much weight should a woman gain during pregnancy
25 to 35 pounds the entire pregnancy
What does the assessment of fundal height allow you to measure?
It is a gross measurement of the approximate weeks of gestation until 36 weeks.
How do you measure fundal height?
From the top of the symphysis pubis to the top of the fundus with a tape measure read in centimeters.
How does an ultrasonography estimate fetal age?
From head measurements of the fetus.
What are the landmark measurements of fundal height for a woman that is 12 to 14 weeks pregnant?
Above the level of symphysis
What are the landmark measurements for fundal height in a woman that is 20 weeks?
At the umbilicus
Approximately how much does the fundal height raise per week?
Approximately 1 cm per week
Fundal height equals weeks of gestation until how many weeks?
36 weeks
If the fundal height is greater than the weeks of gestation what should you suspect?
Hydramnios, multiple gestations, or uterine fibroids may exist.
If fundal height is less than weeks of gestation then what should you suspect?
IUGR maybe present (Interuterine growth restriction)
Increasing the quality of the maternal diet in the year before pregnancy was associated with what?
A reduced risk for congenital disabilities such as neural tube defect’s and orofacial clefts.
When is the greatest risk to the developing embryo present?
17 to 56 days after conception
The first prenatal visit encompasses what assessments?
Health history, past history, reproductive history, physical exam (including a pelvic exam).
What are the typical laboratory tests run on mom during her first prenatal visit?
Blood type and screen: note blood type and RH antibody
CBC: hemoglobin, hematocrit, and platelets
Rubella titers: detect the presence of German measles
Hepatitis BsAg: hepatitis B antibody surface antigen
STI Screen: syphilis, herpes, gonorrhea
HIV: detects HIV antibodies
Cervical smears: PAP test
Until what point of gestation does a woman visit her doctor every four weeks?
Until 28 weeks
During what points of gestation does a woman visit her doctor every two weeks?
29 to 36 weeks
During what points of gestation does a Woman visit her doctor every week?
37 weeks until birth
True or false a woman who has a complicated pregnancy requires additional visits to her doctor?
True
What are the five things performed in a prenatal assessment?
- Weight and blood pressure
- Urine testing for protein, glucose, keytones, and nitrates
- Fundal height
- Fetal movement(quickening)
- Fetal heart rate(110 - 160)
What is a normal fetal heart rate?
110 to 160
The first trimester of pregnancy is during what time frame?
Conception to 13 weeks
The second trimester of pregnancy is during what time frame?
14 weeks to 26 weeks
The third trimester is during what time frame of pregnancy?
27 weeks to birth
The signs and symptoms of pregnancy are grouped into three categories, what are they?
Subjective or presumptive, objective or probable, diagnostic or positive
Presumptive signs of pregnancy are signs that…..?
The mother can perceive
What are the presumptive (subjective) signs and symptoms of pregnancy? Name 4 of the 9
Fatigue (12 weeks) Breast tenderness (3 to 4 weeks) Nausea and vomiting (4 to 14 weeks) Amenorrhea (4 weeks) Urinary frequency (6 to 12 weeks) Hyperpigmentation of the skin (16 weeks) Fetal movements (quickening) (16 to 20 weeks) Uterine enlargement (7 to 12 weeks) Breast enlargement (6 weeks)
Define quickening
The time when the expectant mother first feels fetal movement
When does quickening usually occur?
16 to 20 weeks gestation
What are the probable or objective signs and symptoms of pregnancy? Name 4 of the 10.
Braxton Hicks contractions (16 to 28 weeks) Positive pregnancy test (4-12 weeks) Abdominal enlargement (14 weeks) Ballottement (16 - 28 weeks) Goodells sign (5 weeks) Chadwick's sign (6 - 8 weeks) Hegar's sign (6 - 12 weeks)
What is Chadwick’s Sign?
Bluish purple coloration of the vaginal mucosa and cervix. This is because the body acts to protect the baby by increasing blood flow and softening tissues.
What is Goodell’s Sign?
Softening of the cervix
What is Hegar’s Sign?
Softening of the lower uterine segment or isthmus.
Probable or objective signs of pregnancy are those that…?
Signs that are detected on physical examination by the healthcare professional.
Positive diagnostic signs and symptoms of pregnancy are….?
Confirmation that the fetus is growing in the uterus.
Name the three positive or diagnostic signs and symptoms of pregnancy.
Ultrasound verification of embryo or fetus (4 to 6 weeks)
Fetal movement felt by experience clinician (20 weeks)
Auscultation of fetal heart tones via Doppler (10 to 12 weeks)
Reese is pregnant for the fourth time with a twin pregnancy. She lost a pregnancy at 12 weeks, and had one preterm birth four years ago followed by a term birth after. What is your OB assessment?
G4 P2
T1 P1 A1 L2
In a normal pregnancy, at the age of 34 weeks, the prenatal visits to see your doctor are A) every four weeks B) every other third week C) every two weeks D) every week
C) every two weeks
For the following signs and symptoms of pregnancy, indicate if they are S subjective, O objective, or D diagnostic.
- Amenorrhea
- Palpable fetal movement
- Urinary frequency
- Goodells sign
- Quickening
- Subjective
- Diagnostic
- Subjective
- Objective
- Subjective
Vicky is 28 weeks pregnant during her prenatal visit, her practitioner measured her fundal height of her pregnant abdomen and found it to be 30 cm. What information does the fundal height provide about pregnancy?
It provides the estimated weeks of gestation up until 36 weeks it also estimates the growth of the baby and uterine.
Vicky is 28 weeks pregnant and during her prenatal visit her practitioner measures her fundal height of her pregnant abdomen and it is found to be 30 cm. Interpret the findings of this examination and explain the reason why it is normal or abnormal.
Her fundal height is greater than her pregnancy duration thus far she may have multiple gestations, hydramniosis, or uterine fibroids
Jenny began her last normal menstrual period on March 22 of this year using Nageles rule calculate the expected date of birth EBD.
December 29, 2017
Count back three months from last menstrual period add seven days and one year.
What do the vital signs of a pregnant woman look like
Temp: 99.6
BP 135/ 85 or less (no more than 15-20 mm Hg in systolic over early pregnancy
When a woman is in labor, what should you assess between contractions
Assess BP
How long is the average pregnancy
approx 38.5 weeks
What is the average weight of the fetus
approx 7-8 lbs
What are three functions of Estrogen
1) Suppress FSH & LH
2) Growth of fetal organs
3) Maternal tissue growth
What hormone is responsible for nausea & vomiting
hCG ( Human chorionic gonadotropin)
What hormone is the basis for early pregnancy test and appears in maternal blood
hCG
What is the function of the hCG hormone
Produced by trophoblast
- To maintain corpus luteum
- To secrete progesterone and estrogen before placenta is formed right after implantation
What is hCG produced by
Produced by trophoblast
When does hCG peak
peaks at 8 weeks and gradually decreases
What hormone is detected in a urine pregnancy test to determine if your pregnant
hCG
What are the hormones 6 hormones of pregnancy
- hCG
- hPL
- Relaxin
- Progesterone
- Estrogen
- Oxytocin
List the 4 discomforts of the 2nd trimester
- backache
- varicosities of the vulva and legs
- hemorrhoids
- flatulence with bloating
What is the function of Relaxin
- increases flexibility of pubic symphesis allowing pelvis to expand
- dilates cervix to allow fetus to enter vaginal canal
What is the of Progesterone
” hormone of pregnancy” supports endometrium to provide environment for fetal survival
List 4 ways the uterus adapts to pregnancy
- Increase in size, weight, length, width, depth, volume, and overall capacity
- Pear shape to ovoid shape; positive Hegar’s sign
- Enhanced uterine contractility; Braxton Hicks contractions, painless and irregular UC’s with no cervical changes
- Ascent into abdomen after first 3 months
- Fundal height by 20 weeks’ gestation at level of umbilicus: 20 cm; reliable determination of gestational age until 36 weeks’ gestation.
- 80 to 90% of blood flow goes to the placenta
What is the function of Oxytocin
responsible for stimulating uterine contractions that brings delivery. Also responsible for milk ejection.
How many liters of blood does a pregnant woman’s blood increase by during pregnancy
1-2 Liters, for the support of the baby
What is the reason for the increase in BP during pregnancy
Because of the increase in blood for the baby
What happens when the baby presses up against the stomach while in the mother’s womb
It causes heart burn (gastric reflux)
How much harder does the lungs of the mother have to work during pregnancy
50% harder
July is 20 weeks pregnant and complains of a backache list one measure she can obtain relief through
Avoid sitting or standing in one position for long periods of time
Jenny is 20 weeks pregnant and complains of constipation list one self-care measure she can obtain relief through.
Increase intake of fiber and drink at least eight glasses of 8 ounce water a day
Julie is 20 weeks pregnant and complains of nausea and vomiting provide one self-care measure she can obtain relief from.
Avoid an empty stomach at all times
What causes physiologic anemia in pregnant women?
Hemodilution results in the decreased number of red blood cells, and the increase of plasma volume. Basically plasma volume is greater than red blood cell count
What causes a slow to gastric emptying or pyrosis in pregnant women?
Acid reflex because of progesterone that relaxes the cardiac sphincter of the stomach.
What causes dependent edema in pregnant women?
The uterus causes pressure to be placed on blood vessels in the pelvis and femoral area resulting in impeded blood flow which causes blood pooling.
What causes vena caval syndrome in pregnant women?
Occlusion of the vena cava from compression of a gravid uterus, don’t lay pregnant women flat!
List 4 ways the uterus adapts to pregnancy
- Increase in size, weight, length, width, depth, volume, and overall capacity
- Pear shape to ovoid shape; positive Hegar’s sign
- Enhanced uterine contractility; Braxton Hicks contractions, painless and irregular UC’s with no cervical changes
- Ascent into abdomen after first 3 months
- Fundal height by 20 weeks’ gestation at level of umbilicus: 20 cm; reliable determination of gestational age until 36 weeks’ gestation.
- 80 to 90% of blood flow goes to the placenta
How much blood flow goes to the placenta
80 to 90 % of blood flow
What do you need to make labor active
You need dilation to make labor active
When can the fundal height be palpated
The fundal height can be palpated at 10-12 weeks at symphisis pubis
When is the fundal height most accurate
between 22- 34 weeks
What is the fundal height related to
The fundal height is related to gestational age
How does the cervix adapt to pregnancy
- Softening (Goodell’s sign)
- Mucous plug formation
- INCREASED VASCULARIZATION (CHADWICK’S SIGN)
- Ripening about 4 weeks before birth
- OVULATION CEASES DUE TO HIGH ESTROGEN AND PROGESTERONE LEVELS THAT INHIBIT THE PRODUCTION OF FSH AND LH
List 4 ways in which the vagina adapts to pregnancy
- Increased vascularity with thickening due to estrogen
- Lengthening of vaginal vault
- Secretions more acidic, white, and thick called leukorrhea
- ACIDIC ENVIRONMENT PREVENTS BACTERIAL INFECTION, BUT IS CONDUCIVE TO YEAST (MONILIA) INFECTION DURING PREGNANCY
Why do pregnant women become prone to yeast infections
because of the acidic environment in the vagina that prevents bacterial infections
List 5 ways the GI adapts to pregnancy
- Gums: hyperemic, swollen, and friable
- Ptyalism-increase salivation
- Dental problems: gingivitis
- Decreased peristalsis and smooth muscle relaxation due to progesterone
- Constipation + increased venous pressure + pressure from uterus= hemorrhoids
- SLOWED GASTRIC EMPTYING; HEARTBURN (PYROSIS) DUE TO ACID REFLUX SINCE PROGESTERONE RELAXES CARDIAC SPHINCTER OF STOMACH
- PROLONGED GALLBLADDER EMPTYING & PREDISPOSES TO STONE FORMATION
- Nausea and vomiting
List 3 ways the cardiovascular system adapts to pregnancy
- INCREASE IN BLOOD VOLUME ( 50% ABOVE PREGNANT LEVELS)
- Increase in cardiac output; increased venous return; increased heart rate
- Slight decline in blood pressure until mid pregnancy, then returning to pregnancy levels
- INCREASE IN NUMBER OF RBC’S; PLASMA VOLUME> RBC LEADING TO HEMODILUTION ( PHYSIOLOGIC ANEMIA)
- INCREASE IN IRON DEMANDS, FIBRIN & PLASMA FIBRINOGEN LEVELS, AND SOME CLOTTING FACTORS, LEADING TO HYPERCOAGULABLE STATE
List 3 ways in which the heart adapts to pregnancy
- Displaced up and to the left and rotating it forward
- Heart enlarges
- Systolic murmurs common
- DEPENDENT EDEMA OCCURS WHEN UTERUS CAUSES PRESSURE ON BLOOD VESSELS IN PELVIS AND FEMORAL AREA THUS IMPEDING BLOOD FLOW SO BLOOD POOLING FOLLOWS. ( ALSO REASON FOR VARICOSITIES AND HEMORRHOIDS)
Should you use lasix for pregnant women with edema
NO
What is Supine postural hypotension ( or superior vena caval syndrome)
results from occlusion of vena cava due to compression from gravid uterus
What is the preferred position with pregnancy
side-lying position preferred with pregnancy
What are the effects of positioning during pregnancy
Symptoms: lightheadedness, fainting spells, palpitations
- Danger: decrease oxygen to fetus
List two ways the respiratory system adapts to pregnancy
- Breathing more diaphragmatic than abdominal due to increase in diaphragmatic excursion, chest circumference, and tidal volume
- increase in oxygen consumption
- CONGESTION SECONDARY TO INCREASED VASCULARITY
List 2 ways the urinary system adapts to pregnancy
- 1st trimester: FREQUENT URINATION AS UTERUS PRESSES ON BLADDER
- 2nd trimester: normal because uterus rises to abdomen
- 3rd trimester: GRAVID UTERUS SETTLES DOWN ON PELVIS AND BLADDER THUS FREQUENT URINATION COMES BACK
List 3 ways the renal/ urinary system adapts to pregnancy
- Dilation of renal pelvis; elongation, widening, and increase in curve of ureters
- Increase in length and weight of kidneys. Ureters increase in diameter and become dilated and curved particularly on the right side. Relaxed tone and slowed peristalsis and stasis of urine increases the risk of UTI
- Increased GFR; increased urine flow and volume because kidneys filter maternal and fetal waste
- Increase in kidney activity with woman lying down; greater increase in later pregnancy with woman lying on side
- ENLARGED UTERUS MAY CAUSE PRESSURE ON BLADDER THAT MAY LEAD TO URINARY STASIS AND PYELONEPHRITIS
- Pressure on urethra may lead to poor bladder emptying.
List 3 ways the Musculoskeletal system adapts to pregnancy
- Softening and stretching of ligaments holding sacroiliac joints and pubis symphysis
- Postural changes; increased swayback and upper spine extension
- Forward shifting of center of gravity
- Increase in lumbosacral curve (lordosis); compensatory curve in cervicodorsal area
- Waddle gait because center of gravity shifts
- Back pain, pelvic discomfort may be present
True or False: There is an increase in lordosis of the lumbosacral spine and the increase curvature of the thoracic area
True
List 3 ways the integumentary system adapts to pregnancy
- HYPERPIGMENTATION; MASK OF PREGNANCY ( FACIAL MELASMA OR CHOLASMA) DUE TO PROGESTERONE AND ESTROGEN AND MELANOGENIC STIMULATION
- LINEA NIGRA
- STRIAE GRAVIDARUM - STRETCH MARKS
- VARICOSITIES
- Vascular spiders and palmar edema due to increase in subcutanesous blood flow
- Decline in hair growth; increase in nail growth
List 3 ways of Primary Prevention for Pregnancy
- SEVENTY PERCENT OF WOMAN WHO DO NOT TAKE FOLIC ACID SUPPLEMENTATION INCREASE THE RISK OF NEURAL TUBE DEFECTS. ( NTD’S- LIKE SPINA BIFIDA AND ANENCEPHALY). TAKING FOLIC ACID REDUCES THE INCIDENCE BY TWO THIRDS
- All woman who are childbearing age should take 0. 4mg folic acid daily as soon as they want to become pregnant and should continue to take it during the pregnancy
- SOURCE OF FOLIC ACID: DARK GREEN VEGETABLES SUCH AS BROCCOLI, ROMAINE LETTUCE, SPINACH; BAKED BEANS, BLACK EYED PEAS, CITRUS FRUITS, PEANUTS AND LIVER
List the 7 discomforts of 1st trimester pregnancy
- urinary frequency or incontinence fatigue
- nausea and vomiting
- breast tenderness
- constipation
- nasal stuffiness, bleeding gums, epistaxis
- cravings
- leukorrhea
List the 5 discomforts of the 3rd trimester
- return of the 1st trimester discomforts
- shortness of breath and dyspnea
- heartburn and indigestion
- dependent edema
- braxton hicks contractions
How to manage urinary frequency or incontinence in pregnancy
- Try kegel exercises to increase control over leakage
- empty your bladder when you first feel a full sensation
- avoid caffeinated drinks, which stimulate voiding.
- reduce your fluid intake after dinner to reduce night time urination
How to manage fatigue in pregnancy
- Attempt to get a full night’s sleep, without interruptions
- eat a healthy balanced diet
- schedule a nap in the early afternoon daily
- when you are feeling tired, rest
How to manage nausea and vomiting in pregnancy
- avoid an empty stomach at all times
- munch on dry crackers/ toast in bed before arising
- eat several small meals throughout the day
- drink fluids between meals rather than with meals
- avoid greasy, fried foods or ones with a strong odor, such as cabbage or brussels sprouts
How to manage backache in pregnancy
- avoid standing or sitting in one position for long periods
- apply heating pad ( low setting) to the small area of your back
- support your lower back with pillows when sitting
- stand with your shoulders back to maintain correct posture
how to manage varicosities in pregnancy
- walk daily to improve circulation to extremities
- elevate both legs above heart level while resting
- avoid standing in one position for long periods of time
- dont wear constrictive stockings and socks
- dont cross the legs when sitting for long periods
- wear support stockings to promote better circulation
How to manage hemorrhoids in pregnancy
- establish a regular time for daily bowel elimination
- prevent straining by drinking plenty of fluids and eating fiber rich foods and exercising daily
- use warm sitz bath and cool witch hazel compresses for comfort
how to manage constipation during pregnancy
- increase your intake of foods high in fiber and drink at least eight 8- ounce glasses of fluid daily
- exercise each day( brisk walk) to promote movement through the intestine
- reduce the amount of cheese consumed
how to manage heartburn/ indigestion during pregnancy
- avoid spicy or greasy foods and eat small frequent meals.
- sleep on several pillows so that your head is elevated
- stop smoking and avoid caffeinated drinks to reduce stimulation
- avoid lying down for at least 2 hours after meals
- try drinking sips of water to reduce burning sensation
- take antacids sparingly if burning is severe
how to manage braxton hicks contractions during pregnancy
- keep in mind that these contractions are a normal sensation
- try changing your position or engaging in mild exercise to help reduce the sensation
- drink more fluids if possible
What is couvade syndrome
sympathetic pregnancy, is a proposed condition in which the male partner experiences some of the same symptoms and behavior of the expectant mother.
The stages of the partner’s reaction to pregnancy and changes
- ambivalence = 1st trimester
- acceptance of roles = 2nd trimester
- preparation for reality of new role = 3rd trimester
What are the 9 signs of potential problems to notify provider
- persistent vomiting (may need tpn )
- vaginal bleeding (never good )
- edema of face/ hands
- temp > 101 F
- Persistant abdominal pain, epigastric pain
- dysuria
- intermittent back pain, pelvic pressure
- visual changes
- changes in fetal movement
What is a healthy weight gain and BMI for pregnancy
HEALTHY WEIGHT BMI: 25 TO 35 lbs
- 1st trimester: 3.5 to 5lbs
- 2nd & 3rd: 1lb/ week
BMI < 19.8: 28 to 40 lb
- 1st trimester: 5lb
- 2nd & 3rd: 1+ lb/ week
BMI> 25: 15 to 25lb
- 1st trimester: 2lb
- 2nd & 3rd: 2/3 lb/weekWhat is the average total weight gain in pregnancy
25-35 lbs
What is the increase in calories per day for a pregnant woman
USDA food guide Myplate states pregnancy requires an increase of 300 calories per day over the 1800 to 1200 calories for non- pregnant women
What are the 4 special considerations for nutrition promotion
- cultural variations
- lactose intolerance
- vegetarianism
- Pica
What is Pica
the compulsive desire to ingest nonfood substances during pregnancy like clay, dirt, and chalk
What is included in a fetal assessment
- Fetal heart rate (FHR): significant predictor of fetal well being. Normal = 110-160
- Fetal movement (FM): a regular pattern of 10 movements in 20 min to 2 hours twice a day is a good indicator of fetal well being.
What is considered an abortion
anything less than 20 weeks is considered an abortion
