Pregnant Pop

Question 1

Hormonal changes

Answer 1

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

Question 2

Cardiovascular changes

Answer 2

Erythrocyte mass and plasma volume increase
Cardiac output increases
Systemic vascular resistance and pressure fall

Question 3

Musculoskeletal changes

Answer 3

From weight gain and the hormone relaxin
Lumbar lordosis
Ligamentous laxity in the SI joints and pubic symphysis

Question 4

Anatomy and Physiology

Breast changes

Answer 4

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

Question 5

Pelvic changes

Uterus

Answer 5

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

Question 6

Cervic Chnges

Answer 6

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

Question 7

Ovaries

Changes

Answer 7

generally not noticeable on physical examination

Question 8

Pregnancy

Answer 8

1st trimester up to 14 weeks
2nd trimester 14-27 weeks
3rd trimester 28 weeks to birth

Question 9

Prenatal Care Visits

Initial visit

Answer 9

Confirm the pregnancy with lab tests, US
Assess the health status
Risk stratification for fetus and mother
Counsel, educate, support

Question 10

At every visit check:

Answer 10

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

Question 11

General inspection

Answer 11

Overall health status, emotional state, nutritional status
Vital signs
Baseline blood pressure is very important in establishing

Question 12

Preeclampsia:

Answer 12

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

Question 13

Gestational hypertension

Answer 13

BP becomes elevated >140/>90 after 20 weeks’ gestation

Question 14

Chronic hypertension:

Answer 14

blood pressure is elevated >140/>90 before 20 weeks’ gestation

Question 15

Weight and BMI (body mass index) are very important

Answer 15

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.

Question 16

Nose
Mouth
Thorax

Answer 16

Nose: edema causing congestion is normal

Mouth: periodontal disease is common. Gingivitis.

Thorax and lungs: SOB, check for pathologic

Question 17

Heart
Breasts
Extremeties

Answer 17

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

Question 18

Chloasma

Answer 18

inc. melanin on face

Question 19

Abdominal exam

Answer 19

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

Question 20

Fundal height

Answer 20

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

Question 21

Auscultate the fetal heart rate

Answer 21

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

Question 22

Genitalia

Anus

Answer 22

Genitalia: look for scars from prior deliveries, labial varicosities
Anus: note any hemorrhoids, fissures, or warts present

Question 23

Speculum exam

Answer 23

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

Question 24

Fetal position: Leopold’s Maneuver

First

Answer 24

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)

Question 25

Fetal position: Leopold’s Maneuver

Second

Answer 25

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.

Question 26

Fetal position: Leopold’s Maneuver

Third

Answer 26

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.

Question 27

Fetal position: Leopold’s Maneuver

Fourth

Answer 27

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)

Question 28

Frequency of Prenatal Visits: 1st trimester

Answer 28

Generally, 1 visit is needed during the 1st trimester

full history and physical with lab work.

Question 29

2nd and 3rd trimester

Answer 29

Monthly visit until 32 weeks gestation

Question 30

32 weeks until 36 weeks,

Answer 30

every 2 wks

36 weeks until delivery the patient is seen weekly.

Question 31

During these visits, extra tests

Answer 31

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

Question 32

Every exam emphasize healthy habits. Areas to stress include:

Answer 32

Nutrition
Weight gain
Exercise
Smoking cessation, alcohol, and illicit drugs
Screening for domestic violence
Immunizations

Question 33

Fetal stations

Answer 33

objective measure of fetal head at ischial spine 0 head at ischial spine. 1-3+ inferior or 1-3-(superior)

Question 34

Trimesters

Answer 34

1st up to 14 weeks
2nd 14-27 weeks
3rd 28 weeks to birth