Physiologic Aspects of Antepartum Care (2) Flashcards
Diagnosis of Pregnancy
based on combo of: Presumptive changes (subjective) Probable changes (objective) Positive signs (diagnostic)
Presumptive Changes
amenorrhea n/v fatigue urinary frequency breast changes quickening
Probable Changes
changes in pelvic organs between 6-8 weeks:
Hegar’s sign: softening of isthmus
Goodell’s sign: softening of cervix
Chadwick’s sign: blue/purple color to cervix
enlargement of abdomen and uterus
positive pregnancy test
changes in skin pigmentation
braxton hicks
Positive Signs
These can ONLY be attributed by a fetus: movement auscultation of fetal heartbeat visualization of fetal movement visualization of fetus on u/s
Antepartum Period
1st day of LMP to onset of labor
broken into 3 trimesters:
1st: conception through 12 completed weeks
2nd: 13-28 completed weeks
3rd: 29-40 completed weeks (or delivery)
Gestational Age
referred to in weeks and days
EDD
estimated date of delivery
-best determined with a known and certain LMP
Naegele’s Rule
FIRST day of LMP (Month/Day) - 3 months + 7 days = EDD
*relies on regularity of a woman’s cycle and normal cycle intervals (less accurate if cycles are >28 days apart)
Term Pregnancy
37 weeks through the end of the 41st week
Gravida
any pregnancy, regardless of duration, including present pregnancy
Nulligravida
woman who has never been pregnant
Primigravida
woman who is pregnant for the first time
Multigravida
woman who is in her 2nd or any subsequent pregnancy
Para
birth after 20wks regardless of whether infant born was born alive
Primipara
woman who has had one birth at more than 20wks gestation regardless of outcome
Nullipara
woman who has NOT given birth at more than 2wks gestation
Multipara
woman who has had two or more births beyond 20wks
GTPAL format
G: # of pregnancies including current
T: # of pregnancies delivered at 37wks or later
P: # of pregnancies delivered between 20-36wks regardless of outcome
A: # of pregnancies ending in spontaneous or therapeutic abortion (<20wks)
L: # of currently living children (twins count as 2 here)
Cause of Changes in Woman’s Body during Pregnancy
hormonal influences
growth of fetus w/in uterus
mother’s physical adaptation to the changes that are occurring
hCG
human chorionic gonadotropin: maintains corpus luteum of pregnancy which secretes progesterone to maintain the endometrium until placental production sufficient ~8wks and then the corpus luteum disintegrates and the placenta takes over
Changes to CV System
cardiac output increases pulse frequently increases blood volume increases blood pressure decreases physiologic anemia d/t increased plasma volume WBC levels increased clotting factors off (somewhat hypercoagulable state to decrease risk of PP hemorrhage) Supine Hypotensive syndrome
Changes to Respiratory System
slight increased RR
increased estrogen, progesterone and prostaglandins cause vascular engorgement and smooth muscle relaxation resulting in edema and tissue congestion (nasal congestion, dyspnea, epistaxis)
Changes to Urinary Tract
pressure on bladder causes frequency in first trimester
increased GFR, renal plasma flow, and renal tubular reabsorption
Changes to GI System
- N/V
- reflux, bloating, constipation related to uterine pressure and smooth muscle relaxation from increased progesterone
- appendix is high and to the right along the costal margin by the end of pregnancy
- hemorrhoids d/t increased venous pressure and exacerbated by constipation
Changes to Musculoskeletal System
- pelvic joints soften and increase mobility to facilitate birth process d/t influences of progesterone and relaxin
- round ligament pains
Changes to Skin and Hair
estrogen and progesterone levels stimulate increased melanin deposition leading to hyperpigmentatino of areola, nipples, vulva, perianal area, and linea alba which become linea nigra
melasma
Changes to Endocrine System
Pituitary: prolactin: responsible for lactation oxytocin: promotes uterine contractility and the simulation of milk ejection from breasts vasopressin: causes vasoconstriction to increase BP and has antidiuretic effect hCG hPL Estrogen Progesterone Relaxin Prostaglandins
Changes in Metabolism
fetal demand greatest during second half of gestation - doubles its weight in last 6-8 wks
Frequency of Prenatal Visits
initial visit: between 6-8wks
followed by q4wks visit through 28wks
q2wks through 36wks
weekly visits until delivery
Fundal Height
12wks: symphasis
16wks: half-way to umbilicus
20wks: at umbilicus
McDonald’s method starting around 20wks (tape measure from symphysis to top of fundus and recorded in cm, should correlate w/ wks of gestation from 22-34)
Fetal Heartbeat
~10-12wks
normal range: 110-160bpm
Fetal Kick Counts
assess fetal well being in the 3rd trimester
maternal perception of 10 distinct fetal movements w/in 2 hours considering reassuring
*performed at same time each day
Warning/Danger Signs in 3rd Trimester
PTL Symptoms: Rhythmic lower abdominal cramping or pain low backache pelvic pressure leaking fluid increased vaginal discharge
HTN disorder symptoms:
severe headache that does not respond to usual relief measures
visual changes
epigastric pain
