Pregnancy Flashcards
Define Gravida.
Pregnant woman.
What does Gravidity refer to?
of pregnancies.
number of pregnancies
Define Parity.
of pregnancies where the fetus is born past the point of legal viability; live or dead.
of pregnancies where the fetus is born past the point of legal viability; live or dead; # of pregnancies carried to gestational age >20wks
What is Primigravida?
Pregnant for the 1st time.
Define Primipara.
Delivered 1 child past the age of legal viability; live or dead.
What is Viability in the context of pregnancy?
Capacity to live outside the uterus.
What is the legal viability gestation period?
20 weeks.
What does Functional viability refer to?
24-25 weeks.
Define Multigravida.
Has been pregnant before.
What is Multipara?
Carried 2 or more pregnancies to viability; live or dead.
What does Nulligravida mean?
Never been and is not currently pregnant.
Fill in the blank: TOP stands for _______.
Termination of pregnancy.
What is a Miscarriage?
Spontaneous loss of pregnancy <20th week, most often <12th week.
Define Stillbirth.
Fetus born dead post 20 weeks gestation.
What is the Due date in pregnancy?
40 0/7 days weeks gestation (from start of last menstrual period).
What is considered Early term in pregnancy?
37 0/7 — 38 6/7 weeks of gestation.
What does Full term refer to in pregnancy?
39 0/7 — 40 6/7 weeks of gestation.
Define Late term in pregnancy.
41 0/7 — 41 6/7 weeks of gestation.
What is Postterm in pregnancy?
42 0/7 weeks and beyond.
Define preterm
20 - 37 wks
- extreme preterm <28wks
- very preterm: <32wks
- mod preterm: 32-24sks
when is age of viability during preterm birth
fetus can live outside of the uterus
24-25wks
What are the three trimesters of pregnancy and their week ranges?
- 1st: 1-13 weeks
- 2nd: 14-27 weeks
- 3rd: 28-40 weeks
What significant developmental events occur during the 1st trimester?
Organogenesis and fetal circulation system development.
What is the ‘Golden period’ in pregnancy?
The 2nd trimester, characterized by increased energy and decreased symptoms.
What is Naegele’s Rule used for?
Calculating estimated due date (EDD).
How do you calculate Naegele’s Rule
- based on a 28 day menstrual cycle
- 1st day of last menstrual period - 3 M, + 7 days, + 1yr
what is the purpose of GTPAL
concisely record a pregnancy history
What does GTPAL stand for?
- G: gravidity (twins and triplets counts as one)
- T: term births (> 37wks)
- P: preterm births (twins and triplets counts as one)
- A: abortions (include miscarriages)
- L: living (counted individually, doesn’t include dead)
T + P + A = G
What are Presumptive signs of pregnancy?
Signs that suggest pregnancy but are not definitive
- breast changes
- N/V
- frequent urination
- fatigue
- amenorrhea: no period
- uterine enlargement
- quickening: first movements a mother can feel
When would a mother feel quickening if it’s primigravida vs. multigravida
primigravida: 18-20wks
multigravida: 14-16wks
What are Probable signs of pregnancy?
Objective signs that a healthcare provider may detect
- Urine/serum hCG
- striae gravidarium, melasma, linea nigra, nipples & areola
- fetal outline felt by examiner
- abdominal enlargement
- Chadwick’s sign
- Goodell’s sign
- Hegar’s sign
- Ballottement
what is Chadwick’s sign
blue-purple coloration of the vaginal mucosa, cervix, and vulva @ 6-8wks
due to hypervascularization
what is Goodwell’s sign
softening of the cervix and vagina, increased leukorrhea discharge @ 8wks d/t progesterone
what is Hegar’s sign
softening of the uterine segment @ 6wks d/t progesterone
what is ballottement
light tap of the examination finger on the cervix @ 6-8wks
checks amniotic fluid
sensation of fetal movement
what is linea nigra
dark vertical line on the abdomen from the pubic bone to the navel
What are Positive signs of pregnancy?
signs that confirm pregnancy; objective data
* Fetal heartbeat detected
* Visualization of the fetus via ultrasound
* Fetal movement palpation by the examiner
What is an initial prenatal care history focused on?
Current and previous pregnancies, medical history, and partner’s history.
What is the frequency of prenatal visits from weeks 4-28?
1 visit per month.
what is the frequency of prenatal visits from weeks 28-36?
1 visit q2wks
what is the frequency of prenatal visits from weeks 36-40?
1 visit q week
how do you measure the fundal height
pubic symphysis to the uterine fundus (cm)
what 3 physical markers are there for fundal height
- 12 wks: above the pubic symphysis
- 20-24wks: umbilicus
- 36+ wks: xiphoid process
What screening occurs during the 1st trimester?
- US to confirm pregnancy
- Optional: US for aneuploidy via nuchal translucency
- Cell free DNA screening for trisomy 21, 18, 13; female or male
- Chorionic villi sampling @10-13wks: aspiration of placental tissue for genetic disorders
What is the purpose of a quad screen during the 2nd trimester?
To assess risk for open fetal defects and trisomy 21 & 18.
maternal blood test
quad screen is recommended for those that ___________
- 35+ yrs old
- viral infection during pregnancy
- family hx of congenital disabilities
- exposure to radiation
- diabetic and uses insulin
- harmful meds use during pregnancy
what is amniocentesis for and how is it done
needle into uterine cavity to get amniotic fluid
fetal cells for genetic testing
what tests are done during the 2nd trimester
- quad screen: 15-22wks
- amniocentesis: 15-20wks
- gestational diabetes: 24-28wks
- RhoGAM Rh negative antibody screening: 26-28wks
what tests are done during the 3rd trimester
- Group B strep screening
- fetal daily kick counts, biophysical profile with nonstress test
- fetal nonstress test
- fetal positioning
what are normal daily kick counts
4 movements within 1 hr is good, fewer report to PCP
What does Group B strep screening involve?
Vaginal and rectal swab cultures at 35-37 weeks before labor.
how is the biophysical profile done & what does it test
US with nonstress test
- tests fetal movement, tone (flexing and extending limbs), breathing, amniotic fluid volume
what does the US part of biophysical profile test entail
fetal breathing
- episode of 20+ secs of rhythmic breathing in 30 minutes
fetal movement
- 2+ episodes of torso or limb movement
muscle tone
- 1 episode of bending plus straightening of limb or trunk
qualitative amniotic fluid volume
- 1+ vertical pocket greater than 2cm or more
what score for the biophysical profile test is good and bad
8/10 is good
6: repeat test or consider induction of labor
4: could be fetal asphyxia, induction if 32+ wks
0: induction immediately
what does the fetal non-stress test tell you
autonomic nervous system function
overall oxygenation
what does the fetal non-stress test involve
fetal non-stress test
- <32wks
- reactive: 2x acceleration of 10secs+ of 10+bpm in 20mins
2 accelerations of HR at least 10BPM above baseline and lasting 10 secs in a 20 mins period
- nonreactive: no acceleration within 40mins
what does the fetal stress test tell you
- FHR response to uterine contractions to assess fetal tolerance of labor
- tests placental function and O2 delivery during contractions
what does the fetal stress test involve
fetal stress test
- uterine contractions induced using nipple stimulation or oxytocin
- negative (good): no HR drops after peak of a contraction
- positive (bad): late decelerations of HR with half uterine contractions
what maneuver is done to check fetal positioning
Leopold maneuvers + US
- deep palpation to identify head and body positioning
how does the uterus adapt to pregnancy
Uterus
- Braxton-Hicks contractions: painless, intermittent
- larger size
how does the cervix adapt to pregnancy
Cervix:
- softening: Goodell’s sign
how does the vagina/vulva adapt to pregnancy
Vagina/vulva: increased vascularity
- color change: Chadwick’s sign
- leukorrhea: increased white discharge
- relaxation of vaginal wall & perineal body
- acidic pH to prevent bacterial growth
how does the ovaries adapt to pregnancy
Ovaries
- corpus luteum produces progesterone to maintain endometrium
how do breasts adapt to pregnancy
Breasts
- estrogen & progesterone promotes growth: areola darken
how does the heart adapt to pregnancy
Heart
- enlarges slightly, shifts upwards and left
- CO increased by 30-50% by 24th wk
how does the following change with pregnancy:
- CO
- resting HR
- blood volume
- peripheral resistance
- CO increase
- resting HR increase
- blood volume increase
- decreased peripheral resistance
how does the blood adapt to pregnancy
Blood
- plasma volume increases
- RBC increases
- maternal HCT decreases
- physiological anemia
- varicosities & dependent edema
what are the 4 major changes with blood flow during pregnancy
- more blood in circulation: possible increased HR & CO
- skin requires increased circulation to dissipate heat
- weight of growing uterus obstructs blood return from the veins in legs -> stagnation of blood in lower extremities
- altered blood flow to include utero-placental unit
how does the BP change during pregnancy
BP
- decreased in 1st trimester due to decrease in PVR
- diastolic BP decreases slightly during 2nd trimester then return to baseline
- supine hypotension: enlarged uterus compresses inferior vena cava
how does clotting factors change during pregnancy
Clotting factors
- blood factors increased, hypercoagulable state: reduce hemorrhage postpartum
- coagulation inhibiting factors decrease
- plasma fibrin increases, fibrinogen increases
- no change in platelets or clotting time
what is normal HCT & WBC in pregnancy
- normal HCT 35-44, pregnancy around 30
- WBC: up to 16,000
how does breathing change during pregnancy
- shifts from abdominal to thoracic breathing
- dyspnea, deep breathes, slight resp alkalosis
how does the following change with pregancy:
- RR
- minute ventilation
- functional capacity
- tidal volume
- increased RR
- increased minute ventilation
- decreased functional capacity
- increased tidal volume
- other: dyspnea, resp alkalosis
how does the breasts change with pregnancy
- larger and more tender
- nipples stick out more
- 3rd trimester: colostrum - yellow watery pre-milk may leak
how does the chest physiology adapt in pregnancy
enlarging uterus lifts diaphragm
- increase in chest circumference ~6cm
- increase in costal angle >90 degrees
how does progesterone and estrogen affect respiratory system during pregnancy
- progesterone: decreases airway resistance
- estrogen: increases vascularity of mucous membranes -> epistaxis, nasal stuffiness
how does the mouth change due to pregnancy
- mouth: increased vascularity -> gingivitis, bleeding gums, ptyalism (hypersalivation)
how does the esophagus change due to pregnancy
- esophagus: decreased tone of esophageal sphincter (GERD)
how does the intestines change due to pregnancy
- intestine: progesterone decreases tone and motility -> constipation
how does the gallbladder change due to pregnancy
- gallbladder: hypotonic and longer emptying time -> risk for gallstones
how does progesterone affect the smooth muscle during pregnancy
relaxes smooth muscles (i.e. GI)
how does the renal system adapt to pregnancy
- urinary frequency increases
- dilation of renal structures: urinary stasis -> risk for UTI
- increased GFR: rid of extra waste
- proteinuria & glucosuria
how does the MSK system adapt to pregnancy
- progesterone & relaxin: increased joint mobility, softening of pelvic ligaments and joints “waddling gait”
- lordosis: risk for falls
- diastasis recti during 3rd trimester
how does progesterone & relaxin affect the MSK system
- relaxation of smooth muscles
- increased joint mobility
- softening of pelvic ligament and joints -> waddling gait
What is diastasis recti?
Separation of rectus abdominis muscle due to abdominal distension
how does estrogen & progesterone affect the integumentary system during pregnancy
increased melanin:
- melasma (chloasma): brownish pigmentation of cheeks, nose, forehead — made worse with sun exposure
- striae gravidarum: tear of subq tissue and collagen
- linea nigra
increased vascularity
- varicosities, spider nevi, palmar erythema
how do hairs and nails change due to pregnancy
grows more rapidly
What hormone prepares breasts to produce milk?
Prolactin from anterior pituitary gland
what hormone causes uterine contractions and milk ejection reflex?
oxytocin from posterior pituitary gland
What are striae gravidarum?
Stretch marks caused by growth of breasts, hips, abdomen, and buttocks
Result from tearing of subcutaneous connective tissues and collagen.
how does the endocrine system change with pregnancy
- placenta acts as temporary endocrine gland that produces estrogen and progesterone
- “hot flashes” by increased metabolic rate & increased hormones
- parathyroid gland increases in size to meet requirement for calcium
- posterior pituitary secretes oxytocin at end of term to initiate labor
- anterior pituitary secretes prolactin at birth to induce breast milk
What causes varicosities, spider nevi, and palmar erythema during pregnancy?
Hormone-induced increase in elasticity of vessels and increased venous pressure from an enlarged uterus.
Which hormones are produced by the anterior and posterior pituitary during pregnancy?
Anterior: prolactin
Posterior: oxytocin.
What is the role of human chorionic gonadotropin (hCG) in pregnancy?
Maintains pregnancy by stimulating the corpus luteum to secrete progesterone and estrogen.
What is the recommended weight gain women during pregnancy?
25-35lbs gained with BMI 18.5-24.9
what are some common discomforts during pregnancy
- N/V
- breast tenderness
- heartburn
- backache
- urinary frequency
- constipation/flatulence
- fatigue
- nasal stuffiness, epistaxis
- varicosies, ankle edema
- ptyalism (excess saliva)
- leg cramps
How many calories are recommended for women of childbearing age?
1800-2400 cal/day, plus 300 calories for pregnancy and 500 calories for breastfeeding.
What is the significance of folic acid during pregnancy?
Can decrease the likelihood of neural tube defects.
how much folic acid should a pregnant person take, what if they’re at risk?
0.4mg/day
for those at risk: 1-4mg/day
should start taking 3 months before pregnancy
What should women at risk for neural tube defects do regarding folic acid?
Ask their PCP about a higher daily dose (1-4mg) and start 1-3 months before conceiving.
What foods should be avoided to reduce the risk of listeria during pregnancy?
- Unpasteurized milk
- Hot dogs/luncheon meats
- Soft cheeses
- Smoked seafood
- Pates/meat spreads
What types of exercises are recommended for healthy pregnant women?
Aerobic exercises like walking and running.
exercise will not cause complications
what type of exercises should a pregnant lady avoid
- yoga poses that require lying on the back for a long time
- hot yoga -> overheating
- contact sports, scuba diving, skydiving
What are examples of teratogens?
- Radiation
- Maternal infections
- Chemicals
- Drugs
during what time period that are a pregnancy more susceptible to teratogens
1-2 wks: not susceptible, death and spontaneous abortion common
3-8wks: highly sensitive
9-38 wks: less sensitive
True or False: The effects of teratogens are more common in the first trimester.
True.
What are some danger signs during pregnancy?
- Vaginal bleeding
- Persistent vomiting/diarrhea
- Contractions every 4-6 hours prior to 37 weeks
- Rupture of membranes
- Rapid fluid weight gain
- Continuous headache
- Visual disturbances
- Epigastric pain
- seizures
- Persistent abdominal pain
- painful urination
- chills/fever
- changes in fetal movement pattern after 28wks
