Pregnancy Flashcards
why should you avoid asking pregnant women to spend long periods of lying on her back?
Supine Hypotensive Syndrome = Compression from this position interferes with venous return from lower extremities & pelvic vessels, causing patient to feel dizzy & faint.
During majority of pregnancy exam, patient should be in what positions?
sitting up or left-side lying position (exception - during pelvic exam)
Tolerance of 1st trimester wt. loss due to N/V depends on
pre-pregnancy BMI
Weight loss of 5% of pre-pregnancy weight
Hyperemesis Gravidarum - may lead to adverse pregnancy outcomes
Chronic HTN during pregnancy is
> 140/>90 documented before pregnancy, before 20 wks, & after 12 wks postpartum
Gestational HTN
> 140/>90 first documented after 20 weeks without proteinuria
Preeclampsia
> 140/>90 after 20 weeks with proteinuria
Facial edema after 20 gestational weeks may reflect
Preeclampsia
Localized patches of hair loss
should NOT be attributed to pregnancy (though postpartum hair loss is common)
Anemia may cause
conjunctival pallor
Erosions & perforations of nasal septum are seen in
intranasal cocaine use
Dental problems are associated with
poor pregnancy outcomes - so refer for tot & gum pain or infections
Dyspnea accompanied by increased respiratory rate, cough, rales, or respiratory distress raises concern of
possible infection, asthma, pulmonary embolus, or peripartum cardiomyopathy
Murmurs may signal
anemia
dypnea & signs of heart failure
peripartum cardiomyopathy (particularly in late stages of pregnancy)
Severe focal tenderness of breast with erythema
mastitis
Do cesarean scars always match the orientation of the scar on uterus?
no
Confirm fetal health & gestational age via
formal ultrasound
If fetal movement can’t be felt after 24 weeks
error in calculating gestational age; fetal death or severe morbidity; false pregnancy
Before 37 weeks, regular uterine contractions with or without pain & bleeding
suggests preterm labor
If fundal height is 4 cm larger than expected consider:
multiple gestation; large fetus; extra amniotic fluid; uterine leiomyoma (investigate via ultrasound)
If fundal height is 4 cm smaller than expected consider:
low level of amniotic fluid; missed abortion; intrauterine growth retardation; fetal anomaly (investigate via ultrasound)
Lack of audible fetal heart tones may indicate
fewer wks gestation than expected; fetal demise; false pregnancy; observer error (Always investigate via ultrasound)
After 24 weeks, auscultation of more than one FHR in different locations with varying rates suggests
multiple gestation
These may be pronounced from the muscle relaxation of pregnancy
Cystoceles & rectoceles
A pink cervix suggests
non-pregnant state
Cervical erosion, erythema, discharge, or irritation
cervicitis
Abnormal vaginal discharge
possible candida or bacterial vaginosis (these can affect pregnancy outcome)
Cervical opening or shortening (effacement) prior to 37 weeks
may indicate preterm labor
Irregular shaped uterus suggests
uterine leiomyomata, fibroids, or bicornuate uterus (uterus with 2 distinct cavities separated by a septum)
Adnexal (uterine appendages) tenderness or masses early in gestation
require ultrasound to rule out ectopic pregnancy
why is acute pelvic inflammatory disease rare in pregnancy, especially after 1st trimester?
because adnexae are sealed by gravid uterus & mucous plug
______ often engorge during late pregnancy; they may be painful, bleed, or thrombose
Hemorrhoids
Unilateral severe edema with calf tenderness suggests
deep vein thrombosis
Hand or fascial edema after 20 gestational weeks should be investigated for
preeclampsia
Hyperreflexia may signal
preeclampsia – BUT this must be compared to patients baseline reflexes
______ are used to determine fetal position within maternal abdomen in 2nd trimester
Leopold Maneuvers
Breech presentation during Leopold Maneuver exam
when parts other than head, such as butt or foot present at the maternal pelvis
Fetal buttocks are usually at
upper fetal pole — should feel firm but irregular, & less globular than head
Fetal head should feel
firm, round, & smooth
