Pregnancy Flashcards
Presumptive signs
Changes a woman experiences that make her think she is pregnant.
Amenorrhea
Fatigue
N/V
Urinary frequency
Breast changes- darkened areolae, enlarged Montgomery’s glands
Quickening- slight fluttering movements of the fetus felt by woman.
Signs of pregnancy classified into three groups:
Presumptive
Probable
Positive
Probable signs
Abdominal enlargement- related to changes in uterine size, shape, and position.
Positive pregnancy test
Fetal outline felt by examiner
Probable signs
Hegar’s sign
Softening and compressibility of lower uterus.
Chadwick’s sign
Deepened violet- bluish color of cervix and vaginal mucosa.
Goodell’s sign
Softening of cervical tip
Ballottement
Rebound of unengaged fetus
Braxton Hicks contractions
False contractions; painless, irregular, and usually relieved by walking.
Positive signs (signs that can only be explained by pregnancy)
Fetal heart sounds
Visualization of fetus by ultrasound
Fetal movement palates by an experiences examiner.
Human chorionic gonadotropin
hCG
Production starts as early as implantation.
Can be detected as early as 7-10 days after conception.
Peaks at about 60-70 days of gestation declines until 80 days then gradually increases until term.
hCG
Higher levels can indicated multi fetal pregnancy.
Ectopic pregnancy
Hydatidiform mole
Down syndrome
Lower blood levels may indicate a miscarriage.
Urine samples
First voided morning specimens.
Nagele’s rule
Take first day of woman’s last menstrual cycle. Subtract 3 months, and then add 7 days and 1 year
Gravidity- number of pregnancies
Nulligravida- never
Primigravida- 1st pregnancy
Multigravida- 2 or more
Parity- number of pregnancies in which fetus or fetuses reach viability (approx. 20 weeks) regardless of whether fetus is born alive.
Nullipara- no pregnancy beyond the first stage of viability
Primipara- has completed one pregnancy to stage the viability.
Multipara- has completed two or more pregnancies to stage of viability.
GTPAL
G- gravidity
T- term births (38 wk or more)
P- preterm births (viability up to 37 wks)
A- abortions/ miscarriages (prior to viability)
L- living children
Assessment:
Current knowledge Previous pregnancies Birthing experience Medical Hx (rubella, Hep B) Family Hx Recent or current illness Current meds/ substance abuse Psych Hx Work conditions Exercise and diet habits Clients goals Discuss birthing methods/ pain control
Routine Lab tests
Blood type, Rh factor and presence of irregular antibodies CBC w/ differential, Hgb, Hct. Hgb electrophoresis Rubella titer Hep B Group B streptococcus
Routine Lab tests (continued)
Urinalysis w/ microscopic examination One-hour glucose tolerance Three hour glucose tolerance PAP test Vaginal/ cervical culture PPD Venereal disease research lab HIV Maternal serum alpha-fetoprotein-- used to rule out Down syndrome and neural tube defect.
Clients who are Rh negative
Around 28 weeks administer RhO (D) immune globulin
(RhoGAM) IM
Education
Avoid all over the counter meds without provider knowledge Flu immunization Smoking cessation Tx of infections Genetic testing Exposure to hazardous materials 30 minutes of moderate exercise daily Avoid saunas and hot tubs Consume 2-3 liters of water daily
Rupture of amniotic fluid
Gush of fluid from the vagina
Abruption or previa
Vaginal bleeding
Premature labor
Abruptio placentae
Ectopic pregnancy
Abdominal pain
Changes in fetal activity
Decreased fetal movement may indicate fetal distress
Hyperemesis gravidarum
Persistent vomiting
Gestational hypertension
Severe headaches
Blurred vision
Edema of hands and face
Epigastric pain
Infection
Elevated temperature
Dysuria
Recommended weight gain during pregnancy?
11.2-15.9 kg (25-35 lb) 1-2 kg (2.2-4.4 lb) 1st trimester 1 lb per week for last two trimesters Underweight women 28-40 lbs Overweight 15-25
Calorie increase
340/day during second tri
452/day during 3rd tri
If breasting feeding postpartum additional 330/day 1st 6mo
Additional 400/day 2nd 6mo
Folic acid
Crucial for neurological development and prevention of neural tube defect. 500-600 mcg Leafy vegetables Dried peas Beans Seeds Orange juice Breads and cereals
iron supplements
Increase maternal RBC mass
Best absorbed between meals and w/ vitamin c
Milk and caffeine interfere w/ iron absorption
Stool softener may be used to decrease constipation
Caffeine
Limit to 300 mg/day
Calcium
1,000 mg/ day over 19
1,300 mg/ day under 19
Risk factors for inadequate nutrition
Adolescent Vegetarian (protein, calcium, zinc, B12) Nausea vomiting Anemia Eating disorder Appetite disorder pica Excessive weight gain Inability to gain weight Financially unable to purchase food WIC
Dietary complications
Nausea and constipation:
Eat dry crackers or toast– avoid alcohol, fats, caffeine, and spices
Increase fluids and fiber
Maternal phenylketonuria
Maternal genetic disease: high levels of phenylalanine pose a danger to fetus.
Avoid foods high in protein: fish, poultry, meat, eggs, nuts, dairy products.
Ultrasound:
1-2 quarts of fluid prior to ultrasound
Fill the bladder, lift and stabilize uterus.
Displace the bowel, act as an echolucent to better reflect sound waves.
Biophysical profile BPP
Score of 8-10 is normal
Assesses fetal well being by measuring five variables with a score of 2 or 0 Reactive FHR Fetal breathing movements Gross body movements Fetal tone Qualitative amniotic fluid volume
Alpha fetoprotein
High levels: are associated with neural tube defects such as anencephaly. Spina bifida, omphalocele.
Low levels: Down syndrome, hydatidiform mole.
How many weeks for a full term baby?
37 weeks
At 30 weeks what would a nurse expect to find assessing this preterm baby?
Lanugo, a fine hair covering the body
Greatest between 28-30 weeks
Factors that increase risk for postpartal atony
Precipitous delivery Distended bladder Macrosomic delivery Multiple fetal birth Multi para Polyhydramnios
Physiologic changes preceding labor:
Backache- pelvic muscle relaxation
Weight loss- 1-3 lb weight loss
Lightening- fetal head descends into true pelvis (14 d prior)easier breathing, pressure on bladder, urinary freq.
contractions- Braxton hicks
Energy burst- “nesting response”
GI changes- N/V, indigestion
Rupture of membranes- indicative of imminent labor.
Assessment of amniotic fluid:
Watery clear and pale-straw-yellow color.
Odor should not be foul
Volume between 500- 1,200 mL
Nitrazine paper should be used to confirm.
Nitrazine paper
Amniotic fluid is alkaline
Nitrazine paper should be deep blue indicating pH of 6.5-7.5
Urine is slightly acidic:
Paper will remain yellow.
Five “P”s that affect and define the labor and birth process
Passenger Passageway Powers Position Psychologic response
Passenger:
Fetus and placenta
Size of fetal head/ presentation, lie, attitude, and position affect ability to navigate birth canal.
Presentation:
Part of the fetus that is entering the pelvic inlet first Back of head (occiput) Chin (mentum) Shoulder (scapula) Breech (sacrum or feet)
Lie:
Relationship of the maternal longitudinal axis (spine)
Fetal long. Axis (spine)
–transverse
– parallel
Attitude:
Relationship of fetal body parts to one another.
Fetal flexion: chin-chest extrem.-torso
Fetal extension: chin extended extrem too.
Fetopelvic or fetal position:
Relationship of presenting part of fetus as it relates to one of the 4 maternal pelvic quadrants.
R or L for maternal pelvis
O S M Sc for presenting part of fetus
A P T part of maternal pelvis
Station: measure of fetal descent in CM 0 being at level of ischial spines
Minus stations superior to that an plus stations inferior to that.
Passageway
Birth canal: composed of bony pelvis, cervix, pelvic floor, vagina, and introitus. Size and shape of bony pelvis must allow baby to pass through and cervix must dilate in response to contractions and fetal descent.
Powers:
Uterine contractions: cause dilation of cervix and descent of fetus, involuntary urge to push and voluntary bear down.
Position:
Of woman who is in labor, client should engage in frequent position changes during labor to increase comfort, relieve fatigue, and promote circulation.
*Gravity can aid in fetal descent.
Psychological response:
Maternal stress, tension, anxiety, can produce physical changes that impair the progress of labor.
Urinalysis: clean catch urine sample
Hydration- specific gravity
Nutritional- via ketones
Proteinuria- indicative of gest. HTN
UTI- via bacterial count
Nitrazine paper
Used to confirm that amniotic fluid is present.
Paper should be deep blue indicating pH of 6.5-7.5
Five “P”s
Passageway
Powers
Position
Psychologic response
Passageway
Birth canal– bony pelvis, cervix, pelvic floor, vagina, and introitus(vaginal opening).
Stages of labor:
First stage: Latent-irregular contraction 30-45 sec. Active- reg. contr. 40-70 sec. 4cm Transition-2-3 min reg. cont. 8cm Second stage: 10cm cont 1-2 min Third stage: delivery of neonate Fourth stage: delivery of placenta stabilization of Maternal VS
Pain management: gate control theory
Sensory nerve pathways used by pain sensations to get to the brain will only allow a limited number of sensations to travel at any given time. By sending alternate signals using these pathways pain signals can be blocked.
Pain management:
Sensory stimulation strategies
Aromatherapy Breathing techniques Imagery Music Use of focal points Subdued lighting
Pain man.
Cutaneous strategies
Back rubs and massages
Effleurage- light gentle circular stroking of client’s abdomen w/ fingertips in rhythm w/ breathing during contractions.
Sacral counterpressure- consistent pressure applied using heel of hand against sacral area to counter lower back pain
Heat or cold therapy
Hydrotherapy- increases endorphin levels
Acupressure
Analgesic med risk
Vaginal exam evaluating uterine contractions must be done to verify that labor is well established to avoid slowing progress of labor.
General anesthesia nursing actions:
Ensure client is NPO IV infusion in place Apply anti embolic stockings and SCD Premedicate with antacid Admin. H2 receptor antagonist (Zantac) Reglan- increase gastric emptying
Continuous internal fetal monitoring
Advantages:
Early detection of abnormal FHR patterns Accurate assess. of FHR variability Accurate measurement if intensity Tracing not affected by fetal activity, maternal position changes Or obesity
Disadvantages of continuous internal fetal monitoring.
Membranes must have ruptured with presenting part having descended along with cervix being dilated 2-3cm
Potential risk to fetus if improperly placed.
Contraindicated with vaginal bleeding
Increase risk of infection
Specially trained to perform
Hispanic:
Prefer mother to be present
African American:
Prefer female family members for support.
Asian American:
May prefer mother, partner not active participant, labor in silence, C-Section undesirable.
Native American:
Female nursing personnel
Family involved in birth
Use of herbs
Squatting position for birth.
European American:
Birth is public concern
Focus on technology
Partner expected to be involved
Provider seen as head of health care team.
Single most important indicator of progress of labor?
Cervical dilation: both fetal descent and cervical dilation are caused by contractions.
Transition phase of labor:
Discourage pushing efforts until cervix is fully dilated.
Third stage of labor-
Signs of placental separation from the uterus
Fund us firmly contracting
Swift gush of dark blood
Umbilical cord appears to lengthen
Vaginal fullness on exam
What is a External cephalic version and what are it’s contraindications?
Attempt to manipulate the abdominal wall to direct a malpositioned fetus into normal vertex presentation after 37 weeks of gestation. (High risk of umbilical cord prolapse)
C/I: uterine anomalies, prev. C section, cephalopelvic disproportion, placenta previa, multi fetal gestation, oligohydramnios.
Bishop Score:
Cervical: dilation Effacement Consistency Position Station of presenting part Score of 0-3 for each one
Liver: 3rd trimester
- Alkaline phosphatase increases to 2-4X
* Albumin and total protein decrease
Estrogen:
- Uterine growth
- Increasing blood supply to uterine vessels
- developing ductal system
- hyperpigmentation
- vascular changes in skin
- increased salivation (starch)
- Hyperemia of gums and nasal mucus.
Progesterone
Maintain endometrial layer Prevent spontaneous abortion Prevent tissue rejection of fetus Develop lobes in breast Facilitate deposit of maternal fat stores Relax smooth muscle Increase resp. Sensitivity to CO2 Stimulates ventilation Suppresses immunologic resp. Preventing rejection of baby.
Estrogen effects:
- Increased blood supply to uterus= uterine growth
- develops ductal system
- hyperpigmentation, salivary glands, Hyperemia of gums and nasal mucous membranes.
Progesterone effects:
- Maintaining endometrial layer for implantation
- relaxes smooth muscle of uterus preventing spont. Abortion.
- develops lobes/lobules of breast
- deposit of maternal fat stores
- relaxing smooth muscle: uterus, lower esophageal sphincter, intestines, ureters, bladder.
- increased sens. To CO2
human chorionic somatomammotropin also called human placental lactogen.
Insulin antagonists that makes insulin more available to fetus.
Decreases maternal metabolism of glucose and has her rely more on free fatty acids.
Relaxin:
Inhibits uterine activity
Softens ct of cervix
Lengthens pubic ligaments
What is the third stage and what are the four signs of separation?
Placenta is expelled after is separated from uterine wall. •uterus has spherical shape •uterus rises upward •uterine contractions •vaginal drainage
What is Schultz in regards to placenta?
Shiny fetal side first
What is Duncan in regards to placenta?
Rough maternal side presenting
Regional pain management
•Epidural: s/e = hypotension, bladder distention, prolonged second stage, migration of epidural cath, fever, N/V, pruritus, delayed resp. Dep.
•intrathecal (subarachnoid) opioid anal.
-subarachnoid– spinal block
Systemic drugs:
Opioid analgesics: Demerol, fentanyl
Opioid antagonists: reverse opioid
Adjunctive drugs
Sedatives__ for women fatigued from false labor.
Vaginal birth anesthesia:
Local infiltration for episiotomy or suture
Pudendal block– same as local infiltration.
General anesthesia:
For C/S when mother refuses block or is not a candidate or emergency does not allow.
