Pregnancy Flashcards
Hormonal changes in pregnant women
- Lead to extensive anatomical and physiologic changes in every major body system
- Increases in levels of estradiol, progesterone, and the pregnancy hormones (especially HCG) drive many of the pregnancy-related endocrine and metabolic changes
cardiovascular changes in pregnant women
- Erythrocyte mass and plasma volume increase
- Cardiac output increases
- Systemic vascular resistance and pressure fall
musculoskeletal changes in pregnant women
- Ensue from weight gain and the hormone relaxin
- Lumbar lordosis
- Ligamentous laxity in the SI joints and pubic symphysis
breast changes in pregnant women
- Enlarge moderately
- -Hormone stimulation
- -Increased vascularity
- -Hyperplasia of glandular tissue
- Become more nodular by 3rd month of pregnancy
- From mid-to-late pregnancy
- -Colostrum may be expressed (milky discharge)
- -Areolae darken so the baby can see the nipple
- -Montgomery’s glands are more pronounced (nipple lubrication)
- -Venous pattern increasingly visible
uterus in pregnant women
- Most easily palpable beyond 12 to 14 weeks when it straightens (from early anteverted position) and rises up out of the pelvis
- As uterus enlarges, it rotates to the right to accommodate the rectosigmoid structures on the left side of the pelvis
vagina in pregnant women
- Walls appear thicker and deeply rugated
- Vaginal secretions are thick, white, and more profuse
cervix in pregnant women
- Chadwick’s sign, Hegar’s sign
- Mucous plug
chadwick’s sign
- blue or purple discoloration of the cervix because of vascular congestion
- increase in estrogen and cardiovascular changes
hegar’s sign
softening of the cervix
ovaries in pregnant women
changes generally not noticeable on physical examination
1st trimester
up to 14 weeks, neurologic development, many miscarriages happen here
2nd trimester
14-27 weeks, organ development and growth
3rd trimester
28 weeks to birth, mostly growth
prenatal care visits
- Initial visit
- -Confirm the pregnancy with lab tests, US
- -Assess the health status of the mother
- –Risk stratification for fetus & mother
- -Counsel mother to ensure a healthy pregnancy
- Subsequent visits
- -Assess health status of the mother
- -Assess fetus
- -Educate to ensure a healthy pregnancy
at every prenatal care visit:
- At every visit check:
- -Weight
- -BP
- -Urinalysis
- –Glucose, protein, asymptomatic UTI
- -Examine for edema, fundal height, fetal heart tones
- Other examination techniques and diagnostic studies may be ordered depending on the gestational age and maternal complaints
general inspection of pregnant women
Overall health status, emotional state, nutritional status
Chronic hypertension
blood pressure is elevated >140/>90 before 20 weeks’ gestation
weight and BMI in pregnant women
very important for educating the patient on proper weight gain and nutrition
-Low BMI (<19.9)
28- to 40-lb. gain recommended
-Normal BMI (19.9-26)
25- to 35-lb. gain recommended
-High BMI (26.1-29)
15- to 25-lb. gain recommended
-Obese BMI (>29)
<15-lb. gain recommended
pregnant: head
Head: look for mask of pregnancy (chloasma) and edema
pregnant: hair
Hair: often dry and thinning
pregnant: eyes
Eyes: examine conjunctiva; pallor often means anemia
pregnant: nose
Nose: edema causing congestion is normal
pregnant: mouth
Mouth: examine gums and teeth; periodontal disease is common in pregnancy
pregnant: thorax and lungs
Thorax and lungs: patients complain of shortness of breath
pregnant: heart
Heart: listen for venous hums which are common in pregnancy
pregnant: breasts
Breasts: look for symmetry and color; veins are often prominent; darkening areolae, prominent Montgomery glands
pregnant: extremities
Extremities: varicose veins and edema; check reflexes
abdominal exam
- Inspect for scars (from earlier C-sections), striae, and the linea nigra
- Palpate the abdominal organs for masses
- Palpate the uterus
- -Fetal movement felt by examiner at 24 weeks
- -Contractions can also be palpated by examiner
fundal height
- Measure the fundal height from the superior portion of the pubis symphysis to the top of the fundus
- From 20 weeks to 32 weeks, the fundal height in centimeters should approximate the number of weeks of gestation
auscultation
- Auscultate the fetal heart rate with the Doptone (from 10 weeks) or the fetoscope (from 18 weeks)
- The fetal heart rate will be in the 150s to 160s during the first weeks of pregnancy and in the 120s to 140s by term
pregnant: genitalia
look for episiotomy scars or perineal lacerations from prior deliveries
pregnant: anus
note any hemorrhoids, fissures, or warts present
pregnant: speculum exam
- Note the cervix color (the gravid cervix appears bluish in color, Chadwick’s sign), consistency (softness of cervix during pregnancy is called Hegar’s sign), and shape
- Have patient bear down to look for rectoceles or cystoceles
pregnant: bimanual exam
- Assess how long the cervix is so that during labor the thinning of the cervix can be estimated
- Assess if the external and internal os are open or closed
- In the term patient, assess the station of the presenting part (how inferior the presenting part is compared to the ischial spines)
Leopold’s maneuver
First maneuver
Stand at the patient’s side facing her head. Keep the fingers of the hands together and gently palpate with the fingertips the upper pole of the uterine fundus to determine what part of the fetus is there (e.g., buttocks in a vertex position or head in a breach position)
Second maneuver
Place one hand on each side of the woman’s abdomen, capturing the fetus between the hands. Use one hand to steady the fetus while the other feels for parts (back, elbows, knees, arms, legs, hands, feet). Once the back is determined, the Doptone should be placed there to assess heart sounds.
Third maneuver
Now facing the patient’s feet, use the flat surface of the fingers of both hands to palpate the area just above the pubic symphysis. Note whether the hands diverge with downward pressure or stay together. If the hands diverge, the presenting part has descended into the pelvis. If the hands stay together, the presenting part is above the pelvis.
Fourth maneuver
With your dominant hand, grasp the part of the fetus in the lower pole and, with your non-dominant hand, grasp the part of the fetus in the upper pole. With this maneuver, you are often able to distinguish between a breech and vertex presentation.
frequency of prenatal visits
- Generally, one visit is needed during the first trimester for a full history and physical with lab work
- During the second trimester and in the third trimester until 32 weeks gestation, the patient is seen monthly. From 32 weeks until 36 weeks, the patient is seen every two weeks. From 36 weeks until delivery the patient is seen weekly.
- During these visits, extra tests such as genetic screening (at 10 to 18 weeks), ultrasound (20 weeks), diabetes screening (24 to 28 weeks), and group B strep screening (at 36 weeks) should be performed
- Also problems such as Rh status, anemia, and urinary tract infections can be assessed and managed as needed
health promotion and counseling
- Every exam during the prenatal time is an excellent opportunity to emphasize healthy habits. Areas to stress include:
- -Nutrition
- -Weight gain
- -Exercise
- -Smoking cessation, alcohol, and illicit drugs
- -Screening for domestic violence
- -Immunizations
gestational hypertension
blood pressure becomes elevated >140/>90 after 20 weeks’ gestation
preeclampsia
blood pressure >140/>90 after 20 weeks’ gestation with proteinuria or end-organ damage
-New guidelines last week define HTN as BP >130/80
