Pregnant Pop Flashcards
Hormonal changes
extensive anatomical and physiologic changes all major body system
Inc. in levels of estradiol, progesterone, HCG drive many of the pregnancy-related endocrine and metabolic changes
Cardiovascular changes
Erythrocyte mass and plasma volume increase
Cardiac output increases
Systemic vascular resistance and pressure fall
Musculoskeletal changes
From weight gain and the hormone relaxin
Lumbar lordosis
Ligamentous laxity in the SI joints and pubic symphysis
Anatomy and Physiology
Breast changes
Enlarge moderately-Hormone stimulation
Increased vascularity
Hyperplasia of glandular tissue
Become more nodular @ 3rd month
Colostrum may be expressed.
Areolae darken
Montgomery’s glands are more pronounced.
Venous pattern increasingly visible
Pelvic changes
Uterus
Uterus palpable beyond 12 to 14 wks
straightens (from anteverted) and rises up out of the pelvis
rotates to the right to accommodate sigmoid
Clears for the left side of the pelvis
Cervic Chnges
Chadwick’s sign-blue color on cervix. Early sign,
Hegar’s sign-softer lower uterine segment soft. palable
Mucous plug-prevent ascending infection. @4wks. Falls or disintegrate. W/in cervix, cant see
Ovaries
Changes
generally not noticeable on physical examination
Pregnancy
1st trimester up to 14 weeks
2nd trimester 14-27 weeks
3rd trimester 28 weeks to birth
Prenatal Care Visits
Initial visit
Confirm the pregnancy with lab tests, US
Assess the health status
Risk stratification for fetus and mother
Counsel, educate, support
At every visit check:
Assess health status of the mother and fetus
Educate to ensure a healthy pregnancy
Weight
BP
Urinalysis
Glucose, protein, asymptomatic UTI
Examine for edema, fundal height, fetal heart tones
General inspection
Overall health status, emotional state, nutritional status
Vital signs
Baseline blood pressure is very important in establishing
Preeclampsia:
BP >140/>90 after 20 weeks’ gestation with proteinuria or end-organ damage
SBP > 140 or DBP > 90 after 20 weeks on two occasions at least 4 hours apart in a women with no hx of HTN or
BP >160/110 confirmed within minutes and proteinuria > 300 mg/24hours, +1 on dipstick or protein:creatinine > 0.3
New onset HTN without proteinuria + platelets < 100,000, LFTs twice normal, Cr > 1.1 or doubles, pulmonary edema or new onset cerebral or visual symptom
Gestational hypertension
BP becomes elevated >140/>90 after 20 weeks’ gestation
Chronic hypertension:
blood pressure is elevated >140/>90 before 20 weeks’ gestation
Weight and BMI (body mass index) are very important
Low BMI (<19.9)28- to 40-lb. Normal BMI (19.9-26) 25- to 35-lb. High BMI (26.1-29)15- to 25-lb. Obese BMI (>29)<15-lb.
Nose
Mouth
Thorax
Nose: edema causing congestion is normal
Mouth: periodontal disease is common. Gingivitis.
Thorax and lungs: SOB, check for pathologic
Heart
Breasts
Extremeties
Heart: venous hums common
Breasts: look for symmetry and color; veins prominent; darkening areolae, prominent Montgomery glands
Extremities: varicose veins and edema (3-4+ RED FLAG) face or hand not normal-Preclampsia; check reflexes
Chloasma
inc. melanin on face
Abdominal exam
Inspect for scars (from earlier C-sections), striae, and the linea nigra
Palpate organs for masses
Palpate the uterus
Fetal movement felt by examiner at 24 weeks
Contractions
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
Genitalia
Anus
Genitalia: look for scars from prior deliveries, labial varicosities
Anus: note any hemorrhoids, fissures, or warts present
Speculum exam
Note the cervix color (the gravid cervix appears bluish in color, Chadwick’s sign), consistency (Hegar’s sign), and shape
Have patient bear down to look for rectoceles or cystoceles
Fetal position: Leopold’s Maneuver
First
maneuver(upper fetal pole)
Stand at the patient’s side facing her head.
Keep the fingers of the hands together
gently palpate with the fingertips the upper pole of the uterine fundus
determine what part of the fetus is there (e.g., buttocks in a vertex position irregular feeling, or head in a breach position round and smooth)
Fetal position: Leopold’s Maneuver
Second
maneuver(sides of the maternal abdomen)
Place one hand on each side of 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.
Fetal position: Leopold’s Maneuver
Third
maneuver(lower fetal pole/descent into the pelvis)
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.
Fetal position: Leopold’s Maneuver
Fourth
maneuver(flexion of the fetal head)
Still facing the the feet, position hands on either side of the uterus and identify fetal front and back. Using one hand at a time slide fingers down side of body until reach the cephalic prominence(fetal brow/occiput)
Frequency of Prenatal Visits: 1st trimester
Generally, 1 visit is needed during the 1st trimester
full history and physical with lab work.
2nd and 3rd trimester
Monthly visit until 32 weeks gestation
32 weeks until 36 weeks,
every 2 wks
36 weeks until delivery the patient is seen weekly.
During these visits, extra tests
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
Every exam emphasize healthy habits. Areas to stress include:
Nutrition Weight gain Exercise Smoking cessation, alcohol, and illicit drugs Screening for domestic violence Immunizations
Fetal stations
objective measure of fetal head at ischial spine 0 head at ischial spine. 1-3+ inferior or 1-3-(superior)
Trimesters
1st up to 14 weeks
2nd 14-27 weeks
3rd 28 weeks to birth
