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Maternal Exam 2 > Normal Pregnancy > Flashcards

Normal Pregnancy Flashcards

1
Q

The doctor uses the terminology “antepartum”. What do they mean by this?

A

A prenatal period that lasts from conception to onset of labor

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2
Q

How is gestation calculated?

A

Starts on the first day of your LNMP or last normal menstrual period.

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3
Q

How long is a trimester?

A

1/3 of pregnancy; about 13 weeks

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4
Q

What long are lunar months? How many days is a normal pregnancy?

A

Lunar months are 28 days. 280 days for normal pregnancy (due to 10 month period)

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5
Q

When the other nurse mentions “intrapartum” what do they mean?

A

Onset of true labor until birth of the infant & placenta

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6
Q

What does someone mean by the term “postpartum”?

A

Begins right after delivery & lasts for 6 weeks. Body has to return to non-pregnant state (but that said, you won’t feel pre-pregnant again bc some changes dont go away)

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7
Q

Gravida

A

PG woman or ALL pregnancies.

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8
Q

Nulligravada

A

Never pregnant

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9
Q

Primigravida

A

First pregnancy

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10
Q

Multigravida

A

Pregnant 2 or more times

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11
Q

Para

A

Number of births after 20 weeks only (delivered alive or even as a stillbirth)

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12
Q

Nullipara

A

When you’ve never been able to carry a PG beyond 20 weeks

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13
Q

Primipara

A

First pregnancy delivered older than 20 weeks

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14
Q

Multipara

A

2 or more pregnancies delivered older than 20 weeks. Represents PG not amount of babies. So if you have twins, its still 1.

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15
Q

Stillbirth

A

When an infant is born dead after 20 weeks

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16
Q

Abortion/miscarriage How do you know if it can be counted as a para or abortion legally when you’re not sure how far along mom was?

A

Birth of fetus before 20 weeks If born greater than 500 g it is a para. Less than 500 g is an abortion.

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17
Q

What is GTPAL?

A

G- gravida or number of times ever been PG (including the current one) T - term delivery amount or amount of times she’s delivered between the 38-41 week mark. P - preterm or when you deliver between 20-37 weeks. A - abortion or less than 20 weeks (spontaneous or induced/purpose) L - Living children currently

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18
Q

You’re told a baby was born in the “preterm” stage. What does that mean?

A

Baby was born between 20-37 weeks

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19
Q

You’re reading the chart & it says the mom was “post-term” labor in her first pregnancy. What does this mean?

A

Mom gave birth to baby after 42 weeks (remember , people should deliver at least by 41 weeks bc the placenta isn’t meant to last that long)

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20
Q

What is the meaning of subjective signs in PG?

A

Signs that the woman reports that could mean she is pregnant

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21
Q

List 5 subjective signs of PG

A

Amenorrhea, Nausea/Vomiting, Urinary frequency, Breast tenderness, Quickening.

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22
Q

Why is Amenorrhea an early sign of PG

A

No period is a sign of PG subjective sign of PG

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23
Q

How is N/V an early sign of PG

A

Morning sickness around 6 weeks of gestation that lasts until 12 weeks (could persist for some tho) subjective sign of PG

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24
Q

Why is Urinary frequency an early sign of PG

A

Due to pressure on the bladder from uterus growing

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25
Q

Why does breast tenderness occur in early PG

A

Hormones cause this. Will feel this fairly early and it tingles

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26
Q

How early on can quickening be felt in early PG?

A

Can be felt at 16 weeks especially with multipara or moms with multiple PG past 20 weeks First moms may not know until 20 weeks

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27
Q

Probable signs of PG are noticed by who?

A

The medical professional or anyone doing the exam.

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28
Q

Goodells sign

A

Softer cervix probable sign

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29
Q

Chadwick

A

Blue-ish color of cervix due to increased blood flow probable sign

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30
Q

Hagar’s sign

A

Softening cervix probable sign

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31
Q

Uterine enlargement

A

Cervix will appear larger probable sign

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32
Q

Braxton Hicks

A

Low amplitude intensity of cervix so it flies below pain perception. Need to be above 20-30 mmHg. Again, painless contractions. But they have a positive effect by stimulating growth & blood flow. Not strong enough to evacuate the uterus.

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33
Q

Uterine souffle

A

Maternal HR - not the HR of the fetus.

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34
Q

Why does pigmentation occur?

A

Occurs over time due to estrogen

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35
Q

Chloasma or melasma

A

When you have more melanin in your skin

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36
Q

Abdominal Striae

A

Stretch marks that happen later in PG

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37
Q

Ballottement

A

Baby should be moveable or to float (throughout PG too due to gravity free environment)

38
Q

Linea Nigra

A

Vertical line down to pubis that can get darker (areola becomes darker too).

39
Q

Is PG test a probably finding

A

Yes - bc other things can cause a positive test due to hormones. If you have a hormonal abnormality like hcg, you can get a positive test.

40
Q

Palpation for fetal outline

A

Could be fibroids ??? 18:40

41
Q

Positive signs of Pregnancy

A

These are signs that are only seen when you are for sure pregnant? Which doesn’t really make sense but oh well.

42
Q

List 4 positive signs of Pregnancy

A

Visualization - such as an ultrasound

Fetal Heartbeat - beat that is different than moms, fetal EKG, or just externally demonstrate fetal HR

Fetal movement felt by examiner after 20 weeks .

Fetal movements visible to an examiner - often later in PG

43
Q

When can visualization of the fetus occur?

A

Around 6 weeks - gestational sac Around 8 weeks - fetal parts, cardiac motion

44
Q

When can you doppler a fetal HR? When can you do a fetoscope?

A

10-17 weeks for doppler

fetoscope is after 16 weeks

45
Q

How are your vascular and lymphatic systems affected by PG?

A

They will increase!

46
Q

What fraction of maternal blood volume goes to the uterus?

A

1/6 - which is why women can lose a lot of blood

47
Q

Rate of blood flow

A

450-650 ml/min at term

48
Q

Does the uterus experience hyperplasia or hypertrophy?

A

Hypertrophy in order to accomodate the fetus and fluid.

49
Q

How much does the uterus add in weight per term?

A

Starts at around 2 oz to 2.5 Ibs at term

50
Q

What happens to uterus walls in pregnancy

A

Walls thicken

51
Q

How to measure fundal heigh or McDonald’s measurement

A

Top of uterus or symphysis pubis to top of fundus in cm with tape measurer

52
Q

Fundal height at 12-14 weeks

A

at top of symphysis

53
Q

Fundal height at 22-24 weeks

A

At the level of umbilicus

54
Q

Fundal height at 36-38 weeks

A

xiphoid process

55
Q

Fundal height at 40 weeks (or after lightening) What is lightening?

A

Below the xiphoid When the fetus descends into pelvic cavity to settle and drop below the xiphoid. Baby settles into the pelvic cavity & they are able to breath easier and the urinary frequency occur more due to bladder pressure.

56
Q

When will a primiparas (never PG before) feel their lightening approaching? What about for multiparas?

A

Two weeks before delivery. You get a little bit of a warning. Women who have had multiple PG will feel lightening around labor

57
Q

When does fundal height relate to age?

A

At 20 weeks. This helps us know the avg size of the fetus and the amount of amniotic fluid inside the placenta. It is a good measuring tool essentially & is accurate.

58
Q

What is the operculum?

A

This is the mucus plug that forms in the cervix to keep ascending organisms from invading the uterus. Feels gelatin like or glob like. When you lose it, you’ll just see a big blob of mucus. You may even feel it when it falls out in early labor.

59
Q

Leukorrhea

A

Increase in mucus wetness but it is clear and odorless & related to pregnancy. So, not a sign of any infections. But people will come in & they’ll have to be swabbed but its usually just PG changes. Your body is just washing away organisms.

60
Q

Primary hormone responsible for breast changes in PG?

A

estrogen but progesterone does make some changes.

61
Q

venous congestion

A

It is increased blood flow to the breasts really. Causes noticeable blood vessels && this has to do with breasts getting larger and warmer. Breasts may even tingle

62
Q

Can you get striae on the breasts? Why?

A

Yes - stretch marks on breasts are common due to breakdown of collagen fibers which never repair themselves. Never repairs itself but after delivery will fade to a silver white due to loss of pigment.

63
Q

Colostrum How early can it be produced. What about first time moms?

A

pre-breast pink that is creamy yellow. Can be produced as early as 4 months. First time moms will have it closer to birth but veteran moms will have it sooner due to leakage

64
Q

What hormone is responsible for colostrum and breastfeeding in general?

A

Pro-lactin or the hormone responsible for lactation released after delivery of the placenta & progesterone levels drop which works as feedback to produce the breastmilk

65
Q

How much does blood volume increase ?

Why? When do increase blood vol symptoms previal the most?

A

40-50%

Increase in blood volume is needed bc they lose a lot of blood in delivery.

Between 28-34 weeks blood vol at greatest

66
Q

How much do rbc count increase? Why is this relevant?

What if there’s a big drop?

A

30-40% of rbc increase so not same rate as blood volume.

This leaves a gap lead to the hemodilution which results in psuedoanemia in PG.

H&H will appear low but this is normal. However, if it is excessive, that means someone wasn’t taking their iron.

67
Q

Which ventricle increases in pregnancy?

What about murmurs and palitpations? What next?

A

Left ventricle increases due to workload & volume increase.

These are usually okay. No symptoms. But if they have chest pain or other symptoms, they need a cardiac consult. Most times its normal though.

68
Q

How much will HR increse in PG? Why?

What is the cut off HR?

A

10-15 beats for compensation

100 bpm is too high bc then you’re tachycardic.

69
Q

How does PG affect brachial readings?

What position will make BP lowest?

What position should you always avoid?

A

Highest in sitting position bc they are dangling.

BP of orthostatic or recumbent positon is lower.

70
Q

What position should you tell PG mom to avoid? And why?

A

Don’t let them be supine or just laying down on the back. It will cause hypotension due to compression of the aorta to uterus & so less CO for fetus.

71
Q

What is BP like per trimester? (1, 2, 3))

Should BP ever go up in PG?

A

1st - stable bp

2nd - subtle drop in bp

3rd - go bak up to stable bp

No it should never raise. This could indicate eclampsia, diabetes.. etc

72
Q

Due to compression of the iliac vein..

what can happen?

A

dependant edema below the knee and around ankle especially

varicose veins around vulva and vagina which is more likely in high gravida moms

hemorrhoids due to venous congestionfrom pressure of uterus

73
Q

What happens to resistance of the systemic and pulmonary?

How do we check for this outcome?

A

Resistance decreases which causes an increasd risk of pulmonary edema

Listen to lung sounds, count respirations, 02 sat, coloring. Subjective respiratory complaints to check for pulmonary edema

74
Q

You are checking your patients lab & you see an increase in wbc count. Should you assume infection?

A

No - the neutrophils increase just incase they need to be used.

To rule out infection, look at the differential shift of all the cells bc basophils and rest will be low.

75
Q

How are serum protein levels affected by PG?

What are proteins a sponge for?

When is this concerning?

A

Serum protein will drop due to the increase in blood volume. They become diluted and less concentrated.

Proteins are a sponge for water. And so if proteins drop, the water goes with them into the extracellular compartment to cause edema.

If edema is above the ankles it is a cause for concern.

But anything below the knee is normal & often shifts very quickly.

76
Q

PG mom says her shoes no longer fit. What do you tell her?

A

It is common to grow out of shoe size due to edema shifting the bones & may alter foot size after PG too.

77
Q

What happens to coagulation in PG? What can this lead to?

How much blood should you lose in labor?

What clothing should you wear?

A

coagulation increases in order to protect from hemorrhage after delivery (PPH) but that means you are more prone to clotting! 5-6x more

Less than 500cc

Wear loose clothing when PG to avoid clot increase

78
Q

Description of PG woman who is more likely to develop clots

A

A PG short, overweight, or sedentary will increase clot risk.

79
Q

Treatment for hemorrhaging? route?

half life?

A

txa or Translimic Acid given IV to slow the clot from breaking

half life 1-3 hrs

80
Q

Which side should we try to get mom to lay on?

A

left side BUT if the baby doesn’t like it, the right is fine.

This is due to the venous stasis that can occur bc the uterus causing pressure

81
Q

vena cava syndrome

A

Compression reducing return and so CO decreases

82
Q

Spider nevi or Angiomos description and cause

Will they blanch?

A

Arteriole appearance that makes a spider web pattern on skin. Due to increased estrogen in blood.

No they won’t blanch due to them being blue.

  • will go away after PG
83
Q

How does PG affect sweating?

A

Sweating will increase due to more waste being produced. You’ll just need to shower more.

84
Q

Blood flow to skin and nails _____.

A

increased blood flow.

After delivery hair may fall out temporarily due to hormone changes.

85
Q

What is hyperpigmentation change?

What hormones involved?

Who is more pronounced in?

A

When the skin has spots on it essentially.

Due to melanin or melontropin

and estrogen

More pronounced in darker skin women who get sun exposure.

86
Q

melasma

A

mask of pregnancy. cheek, nose , forhead

87
Q

linea nigra

A

pigmented line from umbilicus to pubic area

88
Q

Nipples and areola changes in PG?

A

they darken

89
Q

Palmar erythema

A

pinkish blotches on palmar surfaces

90
Q

striae gravidarum

do you need anything fancy for these?

A

stretch marks due to loss of collagen and thus weakened connective tissue

No - just use regular lotion.

91
Q
A

Maternal Exam 2 (10 decks)

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