Pregnancy Flashcards
stretch marks is aka
Striae gravidarum
a brownish black pigment vertical strip along the midline skin of abdomen may appear is known as
linea nigra
what is diastasis recti
separation of the rectus abdominis muscles at the midline due to tension on the abdominal with advancing pregnacy
what weeks is the first trimester of pregnancy
weeks 1-end of week 12
what does the uterus look like in the pelvis during the first trimester
uterus is enlarged but is confined to pelvis and retains a pre-pregnancy position
when does the uterus become palpable just above the pelvic rom
week 12-14
what weeks is the second trimester
weeks 13-end of 26
what is the uterus position in second trimester
uterus is in the aneverted position that pushes on the bladder
-slight uterine dextrorotation to accomodate rectosigmoid structures
when does round ligament pain start? where does it cause pain?
second trimester
-pain in the lower quadrants
where is the fundal height at 12-14 weeks
pelvic rim
where is the fundal height at 16 weeks
between the pelvic rim and the umbillicus
where is the fundal height at 20 weeks
at the umbillicus
where is the fundal height at 24-32 weeks
below the xiphoid process
where is the fundal height at 36 weeks
right beneath the 36
what sign is bluish color of the vagina and cervix due to increased vascularity of the pelvis
chadwick’s sign
what sign indicates normal vaginal secretions that are thick, white, or more profuse
Leukorrhea of pregnancy
what sign indicates softening of the cervical isthmus
Hegar Sign
when does the fundal height drop
after 38 weeks- head is getting ready for delivery
what is expelled as a bloody show at delivery
the mucus plug; protects the uterine environment from outside pathogens
where is Adenexae palpable
at the corpus luteum
what is a small nodule on an ovary in early pregnancy that disappears by mid pregnancy
Adnexae
what gland in your breast becomes more prominent?
montgomery glands
when do women secrete colostrum
2nd and 3rd trimester
what are normal changes to the breast
- enlargement
- darker areola
- nipples become larger and more erectile
What three things confirm pregnancy
- urine pregnancy test
- LMP
- ultrasound to confirm dates
what are irregular and unpredictable uterine contractions in the 3rd trimester that is RARELY associated with labor
braxton hicks contractions
what is vomiting with >5% loss of pre-pregnancy weight
hyperemesis gravidarum
what is the menstrual age aka? how is it calculated
gestational age
count the # of weeks and days from the first day of the LMP
Conception age is aka? how is it calculated
Fetal age
2 weeks less than the gestational age
what is conception age indicated for?
IVF conceptions
how is expected delivery date calculated?
EDD
40 wks from the first day of LMP
estimated date of confinement
how long is the pregnancy according to gestational age?
40 weeks
how long is the lengthh of pregnancy according to fetal age
38 weeks
what is Naegele rule to calculated EDD
- begin on first day of LMP
- subtract 3 months
- add 7 days
- add 1 year
why is gestational age 2 weeks longer?
accomodates for 2 weeks of when the women is not pregnant
Gravidity
number of times that a women has been pregnant
parity
number of times that a women has given birth >24, regardless if the child was born alive or stillborn
how does multiple gestation change G0P000
it is counted as 1 pregnancy, one birth but 2 children
What are risk factors for maternal and fetal health
for the women and baby
- tobacco, etoh, drug use
- RX meds and OTC med use
- adequate nutritional intake or risk for diabetes
- intimate partner violence
what family history should be obtained?
- ethnic background of parents
- history of genetic disease
- congenital problems in babies
what 3 plans should be established at the inital prenatal visots
- plans for genetic testing
- plans for breastfeeding
- plans for postpartum contraception
what history should be obtained each visit after the initial
- fetal movement felt by the patient
- contractions
- leakage of fluid
- vaginal bleeding
what is quickening?
the first fetal movement felt around 18-24 weeks earlier in parous women
what does quickening feel like? when is it felt?
sit feels like fluttering wings
18-24 weeks
when are kicks felt? in weeks
18-25 weeks
when are hiccups felt
18-24 weeks
when are pokes felt
29 weeks
when are jabs felt
36 weeks
what physical exam should be conducted at each subsequent visit?
- vital signs (BP and weight)
- fundal height
- verification of fetal heart rate (FHR)
- fetal position
what components should be tested of the urine at each subsequent visit
- infection
- glucose
- protein
what position should the pt be in during early pregnancy
supine position
what position should the pt be in during late pregnancy for physical exam
semi-sitting with knees bent
When do you assess fetal heart tones?
after 10-12 weeks
when do you begin measuring the uterus?
after 20 weeks
why don’t you want pts laying on their back late in pregnancy
compression on the aorta
when does blood pressure normally drop during pregnancy?
2nd trimester
what is melasma
mask of pregnancy
dark spots along the face or neck
what vital sign should be monitored prior to pregnancy
blood pressure
what is melasma aka
cholasma
what is a normal lung finding in a pregnant female? when is it seen
diaphragmatic elevation
can be seen as early as the first trimester
where does the apical impulse go?
rotated upward and toward the left 4ICS
What is the murmur that is heard over the breasts due to increased blood flow and vasculature? when in pregnancy is heard?
Mammary souffle
late pregnancy or during lactation
where is a mammary murmur heard best at?
2nd and 3rd ICS at bilateral sternal borders
what type of murmur is a mammary souffle murmur?
systolic and diastolic but only heard in systolic
what murmur is NEVER normal?
diastolic murmur
how should you investigate discrepancy between measured fundal height and expected fundal height?
ultrasound
what difference in expected vs measured fundal height is concerning
> 4cm larger than expected or smaller than expected (+/-4cm)
when can fetal movement be felt by examiner?
24 weeks
when do you start measuring the fundal height
> 20 weeks gestation
where do you measure the fundal height on the belly?
from the pubic symphysis to the top of uterine fundus
what should the fundal height measurement (in cm) match?
Roughly the weeks pregnant
what can cause a larger fundal height?
- multiple gestation
- large baby
- extra amniotic fluid
- uterine leiomyoma
what can cause low fundal height
- small baby (interuterine growth retardation)
- low amniotic fluid
- missed abortion
- fetal anomaly
when can you auscultate fetal heart tones?
10-12 weeks with a doppler fetal monitor
where should you listen to the heart for 10-18 weeks gestation
along the midline of the lower abdomen
where should you listen to the FHR for 18+ weeks gestation
depends on fetal position
what is the normal FHR
110-160
how should FHR vary from second to second
10-15bpm
when is there increased variability in FHR
late pregnancy >32weeks
what is cervical ectropion
the columnar cells of the inner portion of the cervix migrates to ectocervix and appears as friable darker pin or red
what does adnexal tenderness or masses early in pregnancy possibly indicate?
ectopic pregnancy
REQUIRED US TO RULE OUT
what should be examined for the anus during physical exam
external hemorrhoids
what should be examined for extremities physical exam
- varicositites
- edema
what are the leopold maneuvars used to determine?
fetal position beginning in the first trimester and readiness for vaginal delivery
First maneuvar
- hands on both sides of baby
- determines fetal part is located at the fundus, the upper fetal pole
second maneuver
hands on both sides but lower
* determines the direction the fetal bac kis facing
third maneuver
- hand on the top and bottom of belly
- determines what part of the fetus is at the lower fetal pole and descents into the pelvis
fourth maneuver
- hands on both sides at the lwoer end
- determines the direction and degree of flexion of the head
what is cephalic position
head down, facing into the vaginal canal
what is the breech position
butt down facing the vaginal canal
what is oblique fetal position
head down but kind of sideways
what is transverse fetal positon
baby is laying sideways
Hypertensive moms love Nifedipine
- hydralazine
- labetolol
- alpha-methldopa
- nifedipine
what is the frank breech position
both hips are flexed and both knees are extended
what is the complete breech position
both hips and knees are flexed
what is footling breech
one or both legs are extended below the buttocks
what are the 2 things required for pre-eclampsia diagnosis (way 1)
- SBP >140 or DBP >90 after 20 weeeks on 2 occasions 4 hrs apart OR BP >160/110 within minutes
- proteinurira >300mg/24 hours or protein:Cr >0.3 OR dipstick 1+ prtotein
what is the classification for diagnosing preeclampsia (second way)
new onset HTN without proteinurira but one+ of:
* thrombocytopenia
* impared liver function
* new renal insufficiency
* pulmonary edema
* new onset cerebral or visual symptoms
what is chronic HTN in pregnancy
SBP >140 or DBP >90
present before conception OR diagnosed before week 20
what is gestational HTN
SBP >140 or DBP>90
* first documented after 20 weeks
* without proteinuria or end-organ dysfunction
when does gestational HTN resolve by
12 weeks postpartum
what does HELLP syndrome stand for
H-hemolysis
E-elevated
L-Liver enzymes
L-Low
P-platelets
hemolysis, elevated liver enzymes, low platelets
what is the treatment of preeclampsia
delivery
why does preeclampsia show proteinuria
damaged placenta releases proinflammatory proteins into the circulation
what is the treatment of ectopic pregnancy
methotrexate or surgical resection
what is ectopic pregnancy?
implantation that occurs outside of the uterus
where do ectopic pregnancies most commonly occur
fallopian tube
what are some symptoms of ectopic pregnancy
- syncope
- hemorrhagic shock (if ruptured)
what is the way you can diagnose an ectopic pregnacy
-serum HCG is postive
-urine HCG is negative
