Pregnancy Flashcards
Presumptive signs of pregnancy
Changes felt by the woman (breast, no period, N/V, urinary freq, fatigue, “flutters”)
Probable signs of pregnancy
Changes observed by an examiner (goodell sign, chadwick sign, hear sign, positive test, braxton hicks contractions)
Goodell sign
Softening of the cervix
Chadwick sign
Bluish discoloration of the cervix
Hegar Sign
Softening of the uterine isthmus
Braxton Hicks contractions
Myomas and other tumors
Positive signs of pregnancy
Changes attributed only to the fetus (visualization of fetus, fetal heart tones on doppler, fetal movements palpated or visible)
Where is the fundus at 22-24 weeks gestation?
At the level of the umbilicus
Where is the fundus at term?
At the level of the xiphoid process
What is used as an estimate for the duration of pregnancy?
Fundus Height
Cervial changes during pregnancy
Multipara (oval), nullipara (rounded), increased vascularity, goodell sign
Vaginal changes during pregnancy
Mucosa thickens and connective tissue loosens in prep for delivery, chadwick sign, mucous plug (operculum) barrier against bacteria, secretions are more acidic
Breast changes during pregnancy
Enlargement, sensitivity, tingling, heaviness in response to increased estrogen and progesterone, nipples and areolae become more pigmented, sebaceous glands might be visible (montgomery tubercles), blood vessels are more visible, stretch marks may appear, colostrum
Striae gravidarum
Stretch marks
Cardiovascular changes during pregnancy
Blood volume increases by 40-50%, cardiac output increases, slight cardiac enlargement as a result of increased blood volume and output, increase in fibrinogen and factors VII VIII IX and X
Pulse increase during preg
Between 14-20 weeks and persists to term
BP decrease/increase during preg
Decreases during 1st trimester, continues to drop until 24-30 weeks, gradually increases and returns to prepreg levels by term
Respiratory changes during preg
Ligaments of the rib cage relax as a result of estrogen, diaphragm is displaced, chest breathing replaces abdominal breathing, decreased tolerance for apnea and hypovent, upper respiratory tract becomes more vascular as a result of elevated levels of estrogen (sinus stuffiness and nosebleeds)
Renal changes during preg
Larger volume of urine is held and urine flow is slow due to ureteral obstruction, increased risk of UTI bc pressure by gravid uterus on ureters and increased blood flow to kidneys
Pressure on bladder during preg
Pressure during 1st, symptoms decrease during 2nd, presenting part descends in 3rd and symptoms increase
Integumentary changes during preg
Hyperpigmentation (nipples, areolae, axillae, vulva), stretch marks and linea nigra, palmar erythema, mild itching, angiomas (vascular spiders) of neck, thorax, face, arms, facial melasma (chloasma or mask of preg) blotchy, brownish, hyperpig of skin over cheeks, nose, and forehead
Musculoskeletal changes during preg
Increasing weight of the fetus causes the mother’s posture to change, center of gravity shifts forward, extra strain on muscles, ligaments and joints in the lower back
GI changes during preg
N/V proportional to hCG levels and decreases in the second and third trimesters, delayed gastric emptying bc decreased peristalsis, hemorrhoids bc constipation and pressure on vessels, emptying time of gallbladder decreases may lead to stones, cardiac sphincter relaxes so HB, anesthesia should always assume a full stomach
Normal weight women before pregnancy will gain how much?
25-35 pounds
Underweight before preg
get to normal weight then 28-40 pounds
Overweight before preg
15-25 pounds
Prenatal visits
Every 4 weeks up to 28 weeks, every 2 weeks from 29-36 weeks, every week from 37 weeks to birth
Goals of antepartum testing
Identify fetuses at risk for injury caused by acute or chronic interruption of oxygenation, identify oxygenated fetuses so unnecessary interventions can be avoided
Monitoring begins when?
By 32-34 weeks of gestation
Ultrasounds
High freq sound waves, waves deflect off tissue in abdomen, noninvasive, painless, no known harmful effects to mother or baby
Indications for ultrasounds in 1st trimester
Confirm preg, determine gestational age, rule out ectopic preg, cause of bleeding, maternal abnormalities, visualization for chorionic villus sampling
Indications for ultrasounds in 2nd trimester
Establish or confirm dates and viability, detect polyhydramnios, oligohydramnios, congenital anomalies, intrauterine growth restriction, assess placental location, visualization during amniocentesis
Indications for ultrasounds in 3rd trimester
Detect macrosomia, placenta previa or abruption, placental maturity, fetal position, doppler blood flow, biophysical profile, visualization during amniocentesis and external version
Too much fluid
Polyhydramnios
Not enough fluid
Oligohydramnios
Oligohydramnios would have what kind of
Variable bc cord compressions
Biophysical Profile
Reliable predictor of fetal well-being, used in late 2nd and 3rd, considered as a physical exam of the fetus, including determination of vitals
BPP includes what?
Fetal breathing movements, fetal movements, fetal tone, fetal HR pattern by means of a nonstress test, amniotic fluid index
BPP scoring
2 points for normal findings, 0 for abnormal.
8-10: normal, low risk for chronic asphyxia
4-6: suspect chronic asphyxia
0-2: strongly suspect fetal asphyxia
Macrosomia
Big babies
When do you admin RhoGAM?
28 weeks gestation, again within 72 hours of birth
Amniocentesis
Obtains amniotic fluid which contains fetal cells, possible after 14 weeks
Amniocentesis indications
Diagnosis of genetic disorders or congenital anomalies (neural tube defects), assessment of pulmonary maturity, diagnosis of fetal hemolytic dz
Chorionic Villus Sampling
Removes small tissue specimen from the fetal portion of the placenta, tissues reflect the genetic makeup of the fetus, performed between 10 and 13 weeks, transcervically or transabdominally
Percutaneous Umbilical Blood Sampling
Direct access to the fetal circulation during the 2nd and 3rd, used for fetal blood sampling and transfusion
PUBS indications
Diagnosis of inherited blood disorders, karyotyping of malformed fetus, fetal infection, assessment and tx of isoimmunization and thrombocytopenia in the fetus
Post-PUBS
Continuous fetal heart rate monitoring for 1-2 hours, kick counts at home
Maternal Serum Alpha-fetoprotein
Screening tool for NTD’s in preg, 15-20 weeks but 16-18 weeks is ideal
What is AFP produced by?
Fetal liver and increasing levels are detectable in the serum of preg women from 14-30 weeks
Abnormal MSAFP values mean what?
Follow up genetic testing and counseling
Nonstress test
Most widely applied technique for antepartum evaluation of the fetus, noninvasive, relatively inexpensive with zero complications
What happens if underlying uteroplacental insufficiency exists?
Contractions produce late decelerations
Vibroacoustic stimulation
Performed in conjunction with NST, combination of sound and vibration to stimulate the fetus, monitored for 5 minutes before stimulation to obtain a baseline FHR, stimulation for 3 seconds, should see acceleration in 3 minutes and if not, test may be repeated 3 times. If still no response, further testing is recommended
Contraction Stress Test
Provides a warning of fetal compromise, nipple-stimulated contraction test, oxytocin-stimulated contraction test
Negative CST
At lease 3 uterine contractions in a 10 minute period with no late or significant variable decels
Positive CST
Late deceleration occur with 50% or more of contractions even if there are fewer than 3 contractions in 10
Suspicious or equivocal CST
Prolonged variable or late decelerations occurring with less than 50% of the contractions
Equivocal-Hyperstimulatory CST
Decelerations that occur in the presence of contractions more frequent than every 2 minutes or lasting longer than 90 seconds
Unsatisfactory CST
Failure to produce 3 contractions within a 10 minute window or inability to trace the FHR
