Prenatal Care Flashcards
Amenorrhea
During the first month of pregnancy, such episodes are likely the consequences of
Blastocyst implantation
Amenorrhea
Should generally prompt evaluation for an abnormal pregnancy
First trimester bleeding
Lower reproductive tract changes
Vaginal mucosa appears dark bluish, red and congested
Chadwick sign
Lower reproductive tract changes
Softening of the vaginal portion of the cervix from increased vascularization
Goodell sign
Lower reproductive tract changes
Softening in the consistency of the uterus
Hegar sign
Lower reproductive tract changes
When uterine body and cervix can easily be flexed against one another
McDonald sign
Lower reproductive tract changes
As symetrical softened enlargement of the uterine corner caused by placental development
Piskacek sign
Lower reproductive tract changes
May cause similar softening
Estrogen progestin contraceptives
Associated with pregnancy affects the consistency and microscopic appearance of cervical mucus
Increase in progesterone secretion
Typically seen in the mid portion of the menstrual cycle, makes pregnancy unlikely
Fernlike pattern
Uterine changes
During bimanual examination
It feels doughy or elastic
Uterine changes
Marked that the cervix and uterine body seem to be separate organs
Isthmic softening
Uterine changes
Uterine body is almost globular, with an average diameter of 8cm.
By 12 weeks gestation
Uterine changes
A soft blowing sound that is synchronous with maternal pulse
Uterine soufflé
Uterine changes
A sharp, whistling sound that is synchronous with the fetal pulse
Funic soufflé
Uterine changes
It is produced by the passage of blood through the dilated uterine vessels and is heard most distinctly near the lower portion of the uterus
Uterine soufflé
Uterine changes
Rush of blood through the umbilical arteries and may not be heard consistently
Funic soufflé
Breast and skin changes
Less obvious in
Multiparas
Breast and skin changes
Maybe absent during pregnancy and may also be seen in women taking
Estrogen containing contraceptives
Fetal movements
Maternal perception of fetal movement depends on factors such as
Parity and habitus
Fetal movements
Perceive between
16 and 18 weeks of gestation
Fetal movements
Primigravida may not appreciate fetal movement until
20 weeks
Pregnancy test
Basis of endocrine assays of pregnancy
HCG
Urine
Pregnancy test
Alpha sub unit of HCG is identical to
LH
FSH
TSH
Pregnancy test
HCG prevents involution of the corpus luteum, which is the principal site of progesterone formation during
First 6 weeks of pregnancy
Pregnancy test
Produce HCG amounts that increase during first T
Syncytiotrophoblast
Pregnancy test
HCG can be detected in maternal serum or urine
8-9 days after ovulation
Pregnancy test
Doubling time of HCG
1.4-2.0
Pregnancy test
HCG peak
60-70days
Pregnancy test
HCG plateau
16 weeks
Measurement of HCG
Before 8 weeks
Syncytiotrophoblast and cytotrophoblast
Measurement of HCG
After 8 weeks
Syncytiotrophoblast
Measurement of HCG
Antibodies were developed with high specificity for
Beta subunit
Sonography recognition of pregnancy
Commonly used to accurately establish gestational age and confirm pregnancy location
Transvaginal sonography
Sonography recognition of pregnancy
First sonographic evidence of pregnancy
4-5 weeks AOG
Gestational sac
Sonography recognition of pregnancy
Seen in ectopic pregnancy
Pseudo gestational sac
Sonography recognition of pregnancy
Normal gestational sac implants
Eccentrically in the endometrium
Sonography recognition of pregnancy
Pseudo sac is seen in the
Midline of the endometrial cavity
Sonography recognition of pregnancy
An anechoic center surrounded by a single echogenic rim
Intra decidual sign
Sonography recognition of pregnancy
Two concentric echogenic rings
Double decidual sign
Sonography recognition of pregnancy
Equivoloc findings
Pregnancy of unknown location
Prenatal record
Not pregnant nor ha been pregnant
Nulligravida
Prenatal record
Buntis o nabuntis irrespective to outcome
Gravida
Prenatal record
First pregnancy
Primigravida
Prenatal record
With successive pregnancy
Multigravida
Prenatal record
Never completed a pregnancy beyond 20 weeks
Nullipara
Prenatal record
Delivered only once
Primipara
Prenatal record
Completed two or more pregnancies to 20 weeks gestation or more
Multipara
Prenatal record
Determined by number of pregnancy reaching 20 weeks
Parity
Normal pregnancy duration
Mean duration
First day of the last menstrual period is very close to 280 days or 40 weeks
Normal pregnancy duration
Naegele rule formula
-3 +7 +1 from the first day of last menstrual period
Normal pregnancy duration
Assumes pregnancy begun approximately 2 weeks before ovulation but not always the case
Gestational menstrual age
Normal pregnancy duration
Assumes pregnancy begun after the start of LMp
Used by embryologist
Ovulation/ fertilization age
1st trimester
Up to 14 weeks
2nd trimester
Up to 28 weeks
3rd trimester
Up to 42 weeks
Pathological mechanism of cigarette smoking
Increased carboxyhemoglobin
Reduced utero placental blood flow
Direct toxic effect of nicotine
Fetal nicotine exposure > maternal
Clinical evaluation
Perform as part ofthe evaluation
Pelvic examination
Clinical evaluation
Bluish red passive hyperemia of the cervix
Chadwick sign
Clinical evaluation
Dilated, occluded cervical glands bulging beneath the ectocervical mucosa
Nabothian cysts
Clinical evaluation
The cervix is not normally dilated except at the
External OS
Clinical evaluation
To identify cytological abnormalities
Done during 1st prenatal visit
Pap smear
Include
Chlamydia trachomatis
Neisseria gonorrheae
All pregnant women should be screened for these at the first visit
Hep B
Syphilis
Rubella
Most accurate tool for gestational age assignment and is performed as clinically indicated
First trimester crown rump length
Can also provide an estimated gestational age, but with declining accuracy
Sonographic interrogation
6 weeks AOG
Uterine size ORANGE
8 weeks AOG
Uterine size LARGE ORANGE
12 weeks of AOG
Uterine size GRAPE fruit
Presumptive sign
Amenorrhea NV Change in breast size Increase urinary frequency Fatigue
Probable sign
Enlargement of uterus Hegar sign Chadwick sign Goodell sign Piskacek sign HCG Chloasma Linea Nigra Quickening
Positive sign
FHT
Leopolds maneuver
Fetal outline on X-RAY
Amenorrhea
Not reliable pregnancy indicator until
10 days or more after expected menses