OB Exam 1 Flashcards
Gravidity
Number of pregnancies
Parity
Number of pregnancies reaching 20 weeks
Preterm and late preterm
20 weeks 0 days to 37 weeks 0 days
34 weeks 0 days to 38 weeks 6 days
Early Term
37 weeks to 38 weeks 6 days
Full term
39 weeks to 40 weeks 6 days
Late term
41 weeks 0 days to 41 weeks 6 days
Post Term
Beyond 42 weeks gestation
What is the earliest biomarker for pregnancy
Human chorionic gonadrotropin (hCG)
What can higher levels of hCG be associated with?
Abnormal gestation such as down syndrome or multiple gestation
What can lower levels of hCG be associated with?
Indicate an impending miscarriage or ectopic pregnancy
When can you first palpate the fundus?
12-14 weeks above the symphysis pubis
When does the fundus rise to the umbilicus
20 weeks
What is lightening?
When the fetus begins to descend into the pelvis between 38-40 weeks
Hegar’s Sign
Softening and compressibility of lower uterine segment around week 6
When do braxton hicks begin to happen?
After 4 months
Goodell sign
Softening of uterine tip
Increased friability
tissue is damaged easily
Ballottement
passive movement of unengaged fetus
Quickening
First recognition of fetal movements
Chadwick sign
Blue-violet vaginal mucosa and cervix from increased vascularity
Leukorrhea
White or greyish discharge
What increases the risk for yeast growth?
Higher glycogen levels
Stretch marks
Striae gravidarum
What causes supine hypotension?
Compression of vena cava when lying flat on back
What causes dependent edema, varicose veins, and hemorrhoids?
Compression of iliac veins and inferior vena cava by uterus
When do WBC increase?
During the second trimester and through delivery
What does increased vascularity cause in the mother?
Congestion, epistaxis, and changes to voice
What causes the increased susceptibility to UTIs?
Urine held in pelvis and ureters, slowed urine flow
Melisma
Mask of pregnancy: Blotchy brownish hyperpigmentation of skin over cheeks, nose, and forehead
Linea nigra
Line extending from symphis pubis to top of fundus
Angiomatas
Vascular spiders. Result from increased blood flow to skin
Palmar erythema
Pinkish red well defined blotches over palmar surfaces
Viability
Capacity to live outside the uterus. There is no clear limits of gestational age or weight. Threshold 22-25 weeks
Presumptive signs of pregnancy
Period absent (amenorrhea) Really tired (fatigue) Enlarged breast Sore breast Urination increases Movement perceived (Quickening) Emesis/nausea
Probable signs of pregnancy
Positive pregnancy test
Return of fetus when uterus pushed with fingers (Ballottement)
Outline of fetus palpated
Braxton Hick’s Contractions
A softening of the cervix tip (Goodell sign)
Bluish color of vulva/vagina/cervix (Chadwick sign)
Lower uterine segment soft (Hegar sign)
Enlarged uterus
Positive signs of pregnancy
Fetal heart tones
Delivery of a baby
Ultrasound of a baby
Physiologic anemia of pregnancy
Result of hemodilution (plasma increase > RBC increase) = low H&H count
PEP/PUPP
Pruritis. Itchy, uncomfortable rash that will last all 40 weeks
Changes in abdominal muscles
Diactasis recti
What results due to edema of peripheral nerves?
Carpal tunnel
PICA
nonfood cravings
Pyrosis
Heartburn as a result of decreased tone and motility of smooth muscles
Maternal morality
Number of deaths per 100,000 live births. This is preventable with improved access and prenatal care services
Maternal morbidity
High-risk pregnancy, acute renal failure, sepsis, and stroke
Importance of prenatal period
Preparing for birth, influencing health of family, and health promotion interventions
How long is pregnancy and how many trimesters?
9 months, 280 days, 3 trimesters each 13 weeks
Stages of maternal adaptation
Accepting the pregnancy
Identifying with the mother role
Reordering personal relationships
Establishing a relationship with the fetus
Phase 1: I am pregnant
Phase 2: I am going to have a baby
Phase 3: I am going to be a mother
Preparing for birthPaternal adaptation
Accepting the pregnancy
Announcement phase- few hours to few weeks where father accepts biologic fact of pregnancy
Moratorium phase- adjusting to the reality of pregnancy
Focusing phase- last trimester, active involvement in pregnancy, building relationship with child
Identifying with the father role
Reordering personal relationships
Establishing a relationship with the fetus
Preparing for the birth
Goal of prenatal care
Promote health and well-being of pregnant woman
Reasons prenatal care are inaccessible
Poverty, lack of health insurance Lack of culturally sensitive care and communication barriers Lack of transportation Inconvenient clinic hours Personal and cultural beliefs
Prenatal interview
Reason for seeking care, current pregnancy, OB history (G’s & P’s and STI history), Medications being taken, nutritional history, history of drug and herbal preparation use, family history, social, experimental, and occupational history, mental health screening, intimate partner violence (Often begins during pregnancy)
Lab test
H&H (anemia and baseline)
Blood type (Rh incompatibility or ABO incompatibility)
Rubella titer
Chlamydia (done first visit)
GBS (done at 35 to 37 weeks)
RPR/VDRL (first visit; screening for syphilis)
HIV
Hep B surface antigen
1hr and 3hr glucose testing
Urine (trace albumin and protein is expected but increased levels could indicate preeclampsia, glucose indicates gestational diabetes)
Weight gain
2 to 4 lbs in first trimester
1lb per week
Total of 25 to 35 lbs during entire pregnancy
Frist trimester education
Discomfort usually subsides after 13 weeks; plan rest periods; can still travel but ensure frequent movement to prevent DVT
Second trimester education
Dental hygiene need to be maintained due to gum hypertrophy
Third trimester education
Attending birth classes, return of urinary frequency; positioning with pillow, expect round ligament pain
Teenagers prenatal care
Don’t get access to prenatal care, more likely to smoke, increased risk for newborn including preterm birth, chorioamnionitis, and inadequate weight gain
+35 years prenatal care
Increased risk for preexisting conditions such as diabetes and HTN
Increased risk for miscarriage, cesarean section, and pregnancy related mortality
Multifetal pregnancies prenatal care
Increased risk for adverse outcomes, premature birth, more frequent visits, changes to weight gain and nutritional needs, and increased stressors such as finances, space and workload
Folic acid needs
400 mcg during prenatal period
600 mcg during pregnancy
Why is nutrition important during pregnancy
Development of placenta, increased blood volume and metabolic rate, and increased energy needs
Proteins needed during pregnancy
25 g/day for 71 g total
Iron needs during pregnancy
27 mg/day total
Foods to avoid
Raw lunch meats, raw eggs, and fish high in mercury
How to prevent nausea/vomiting and heartburn
Small meals that are low in fat, eat crackers in morning before getting out of bed, avoid spicy foods, don’t take iron on an empty stomach, and small glasses of water
Risk if mom is underweight
Preterm labor, low birth weight infants, IUGR (intrauterine growth restrictions)
Risk if mom is overweight
Preeclampsia, gestation DM, macrosomia, cepholopelvis disproportion, wounds, postpartum hemorrhage, miscarriages, congenital/growth abnormalities
Classifications of BMI
Underweight: <18.5
Normal: 18.5 to 24.9
Overweight : 25 to 29.9
Obese: >30
What increases absorption of iron
Vitamin C (citrus fruits, tomatoes, strawberries)
What decreases absorption of iron
Bran, tea, coffee, milk, oxalate (in spinach) and egg yolk
