Physiologic Aspects of Antepartum Care (2)

Question 1

Diagnosis of Pregnancy

Answer 1

based on combo of:
Presumptive changes (subjective)
Probable changes (objective)
Positive signs (diagnostic)

Question 2

Presumptive Changes

Answer 2

amenorrhea
n/v
fatigue
urinary frequency
breast changes
quickening

Question 3

Probable Changes

Answer 3

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

Question 4

Positive Signs

Answer 4

These can ONLY be attributed by a fetus:
movement
auscultation of fetal heartbeat 
visualization of fetal movement
visualization of fetus on u/s

Question 5

Antepartum Period

Answer 5

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)

Question 6

Gestational Age

Answer 6

referred to in weeks and days

Question 7

EDD

Answer 7

estimated date of delivery

-best determined with a known and certain LMP

Question 8

Naegele’s Rule

Answer 8

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)

Question 9

Term Pregnancy

Answer 9

37 weeks through the end of the 41st week

Question 10

Gravida

Answer 10

any pregnancy, regardless of duration, including present pregnancy

Question 11

Nulligravida

Answer 11

woman who has never been pregnant

Question 12

Primigravida

Answer 12

woman who is pregnant for the first time

Question 13

Multigravida

Answer 13

woman who is in her 2nd or any subsequent pregnancy

Question 14

Para

Answer 14

birth after 20wks regardless of whether infant born was born alive

Question 15

Primipara

Answer 15

woman who has had one birth at more than 20wks gestation regardless of outcome

Question 16

Nullipara

Answer 16

woman who has NOT given birth at more than 2wks gestation

Question 17

Multipara

Answer 17

woman who has had two or more births beyond 20wks

Question 18

GTPAL format

Answer 18

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)

Question 19

Cause of Changes in Woman’s Body during Pregnancy

Answer 19

hormonal influences
growth of fetus w/in uterus
mother’s physical adaptation to the changes that are occurring

Question 20

hCG

Answer 20

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

Question 21

Changes to CV System

Answer 21

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

Question 22

Changes to Respiratory System

Answer 22

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)

Question 23

Changes to Urinary Tract

Answer 23

pressure on bladder causes frequency in first trimester

increased GFR, renal plasma flow, and renal tubular reabsorption

Question 24

Changes to GI System

Answer 24

• 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

Question 25

Changes to Musculoskeletal System

Answer 25

• pelvic joints soften and increase mobility to facilitate birth process d/t influences of progesterone and relaxin
• round ligament pains

Question 26

Changes to Skin and Hair

Answer 26

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

Question 27

Changes to Endocrine System

Answer 27

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

Question 28

Changes in Metabolism

Answer 28

fetal demand greatest during second half of gestation - doubles its weight in last 6-8 wks

Question 29

Frequency of Prenatal Visits

Answer 29

initial visit: between 6-8wks
followed by q4wks visit through 28wks
q2wks through 36wks
weekly visits until delivery

Question 30

Fundal Height

Answer 30

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)

Question 31

Fetal Heartbeat

Answer 31

~10-12wks

normal range: 110-160bpm

Question 32

Fetal Kick Counts

Answer 32

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

Question 33

Warning/Danger Signs in 3rd Trimester

Answer 33

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