Pregnancy Flashcards
enlarged uterus initially caused by
elevated estrogen and progesterone
enlarged uterus later caused by
mechanical pressure after first trimetser
by what point does the uterus reach the abdominal cavity
12 weeks
uterine weight increases by
10 fold
uterine capacity increases by
500-1000 x
cardiovascular changes seen by
5 weeks
what happens to heart? 7 things
enlarges, shifts upward and to left; axis changes; increase HR; increase CO; decreased vascular resistance; splitting 1st heart sound(systolic murmur)
upper respiratory changes? five things
SOB, increased secretions, swollen mucus membranes, increased epistaxis, chronic cold symptoms
what impact does progesterone have in GI system?
relaxes sphincters, leads to GERD
bowel changes
slower transit time leads to constipation
N/V treatmetn
B6 and unisom
zofran SE
heart defects and cleft palate
kidney changes
enlarge
ureter changes
dilate
what’s not uncommon to see with kidneys?
hydronephrosis (just watch for infection)
bladder changes
increases vascularity and decreases capcity
UA changes
proteinuria (not concerning unless seen with HTN)
breast changes
increased vascularity; heaviness and pain (6 weeks)
nipple and areola changes
hyperpigmented, erectile, Montogomery tubercle more prominent and raised (8-20 weeks)
when does colostrum secretion begin?
16 weeks
derm changes
linea nigra; chloasma; striae
mask of pregnancy
cholasma
MSK changes
increased lumbar lordosis; widening of pubic symphysis; loosening of SI and pubic joints
triglyceride changes
increase
total cholesterol changes
increase
LDL changes
increase
pancreas changes
fasting hypoglycemia; postprandial hyperglycemia
thyroid changes
increase in size; slight decrease in TSH
fetus dependent on maternal thyroid hormone until
12 weeks
adrenal changes
increased cortisol; increased aldosterone; ACTH
pituitary changes
increase in size; susceptible to bleeding; prolactin and oxytocin increase
dental changes
tooth sensitivity; bleeding gums; increased susceptibility to bacteria
severe gum disease is linked to
preterm labor and LBW
diagnose pregnancy with
serume or urine assay for beta-human chorionic gonadotropin
may detect pregnancy as early as X from missed period
4-7 days
US can confirm pregnancy as early as
5 weeks
Fetal heart rate at
6 weeks
GTPAL stands for
gravidity, parity (term, preterm, abortions, living children)
term pregnancy
37-42
preterm pregnancy
20-36
abortions
spontaneous or induced; before 20 weeks
no delivery
nulliparous
first delivery
primaparous
previously delivered
multiparous
EDD
Add 1 year year to first day of last menstrual period, subtract three months; add 7 days
average duration
280 days or 40 weeks
x cm per week in fundal height
1 cm
just above pubic symphysis
12 weeks
midway between pubis and umbilicus
14-16 weeks
level of umbilicus
20-22 weeks
height equal to gestation age in weeks by
22-38 weeks
2-3 cm below xiphoid process
38-40 weeks
Chadwick sign
cervix, vagina, and vulva bluish color due to increased vascularity
Goodell’s sign
softening and cyanosis of cervix after 4 weeks
effacement
thinning of cervix
cervix will gradually thin to
only a few mm
which comes first in the primavera? effacement or dilation
effacement
dilation
opening of the cervical canal
Fetal heart rate at
11-12 weeks
fetal movement appreciated by mother at
16-20 weeks
fetal movement times per hour
10 times in 1 hour to 10 times per 12 hours
start monitoring fetal movement at
34-36 weeks
Leopold Maneuvers: A
fetal pole–fetal lie; longitudinal or transverse
Leopold Maneuvers: B
umbilical pole–small parts/big parts; which ways is back facing
Leopold Maneuvers: C
Pawlicks Grim–confirms cephalic
Leopold Maneuvers: D
pelvic group–attiude (what is presenting and how); attitude; head flexed or extended
station
relationship of the presenting part of the ischial spines of the mother’s pelvis
Braxton Hicks begin as early as the
third month
how does the uterus position change?
more anteflexed during the first three months
bleeding in early pregnancy can mean
ectopic pregnancy
bleeding in late pregnancy can mean
abruptio placentae: separation of placenta from the site of uterine implantation before delivery
Initial pregnant visit at
6-8 weeks
no brush after
10 weeks
test for gestational diabetes at
24-28 weeks
initial glucose test
drink glucose; one hour later; test. <130-140 is normal
Follow-up glucose testing
fast overnight, then test blood sugar level. Then drink another higher concentration glucose drink. Check every hour for three hours. If at least two are higher, then you have gestational diabetes.
A prior child weighing over x pounds then you might consider earlier glucose testing?
9 lbs
Rectus abdominal muscles separate
diastasis recti
umbilicus changes
flattens or protrudes
gallbladder changes
becomes distended, decreased emptying time and change in tone
what type of stones are you higher risk for?
gallstones (second and third trimesters)
dilation of the ureter is greater on the?
right side
ureter changes in shape
elongate and form single and double curves which can lead to urinary statis
renal function is most efficient if the individual
lies in the lateral recumbent position
renal changes can last up to
3-4 months after delivery
trigone changes
deepening and widening which may lead to microhematuria
colon location changes
displaced laterally upward and posterior
colon changes
peristaltic activity decreases; water absorption increases –> bowel sounds diminished, constipation and flatus common
appendix position changes
upward and laterally
immediately after delivery, the uterus is approximately the size of a
20 week pregnancy (palpable at umbilicus)
by end of first week post-partum, uterus is approximately size of
12 week pregnancy (palpable at pubic symphysis)
muscles of pelvic floor take how long to recover
6-7 weeks
protrusion of naval can indicate
umbilical hernia
ectopic pregnancy pain
lower quadrant, refers to shoulder; with rupture, agonizing
symptoms of ectopic pregnancy
hypogastric tenderness, symptoms of pregnancy, spotting, irregular menses, soft abdominal wall, mass on bimanual pelvic examination
symptoms of rupture ectopic pregnancy
shock, rigid abdominal wall, distension, Kehr, Cullen
Kehr sign
abdominal pain radiating to left shoulder
Cullen sign
ecchymosis around umbilicus
two signs of ectopic pregnancy
Kehr and Cullen
four pelvic joints
symphysis pubis; sacrococcygeal; two sacrioiliac joints
what hormones are responsible for softening of the pelvic cartilage and strengthening of the pelvic ligaments
relaxin and progesterone
pelvic joints separate and lead to what type of gait
waddle
symphysis pubis returns to prepregnancy state within
3-5 months
the cervical canal is obstructed with what after conception?
thick mucus protecting the infant from infection
what dislodges at beginning of labor?
“bloody show”
pH of vaginal secretions
acidic due to lactic acid
acidic vaginal pH can lead to
candida infection
cervix is located
midline
cervix consistency
softer
painful cervical movements can mean
ruptured tubal pregnancy
trimester length
slightly more than 13 weeks (3 months)
is early uterine enlargement symmetric?
maybe not
a variation of fundal height of x cm should be evaluated
2 cm
if uterus is smaller than expected, think:
intrauterine growth restriction
goodell occurs around
4-6 weeks
hegar
softening of the uterine isthmus
goodell
softening of the cervix
hegar at
6-8 weeks
mcdonald
fundus flexes easily on the cervix
mcdonald at
7-8 weeks
braun von fernwald
fullness and softening of teh fundus near the site of implantation
braun von fernwald at
7-8 weeks
piskacek
palpable lateral bulge or soft prominence of one uterine cornu
piskacek at
7-8 weeks
chadwich
bluish color of cervix, vagina, and vulva
chadwich at
8-12 weeks
shortening of the cervix (less than 29 mm midpregnancy) can mean
risk for preterm delivery
