Prenatal Period Flashcards
Gestation
Time from fertilization of the ovum until the date of delivery.
About 280 days
Naegele’s rule
Requires that the woman have a regular 28 day menstrual cycle.
Subtract 3 months and add 7 days to the first day of the last menstrual period.
Add 1 year if appropriate.
Alternatively, add 7 days and count forward 9 months.
Gravidity
Gravida refers to a pregnant woman.
Gravidity refers to the number of pregnancies.
A nulligravida is a woman who has never been pregnant.
A primigravida is a woman who is pregnant for the first time.
A multigravida is a woman in at least her second pregnancy.
Parity
Is the number of births (not the number of fetuses) carried past 20 weeks of gestation, whether or not it was born alive.
A nullipara is a woman who has not had a birth at more than 20 weeks gestation.
A primipara is a woman who has had 1 birth at more than 20 weeks gestation.
A multipara is a woman who has had 2 or more pregnancies to the stage of fetal viability.
GTPAL
G is gravidity (number of pregnancies)
T is term births (longer than 37 weeks)
P is preterm births (before 37 weeks)
A is abortions or miscarriages (including before 20 weeks).
L is the number of current living children.
** multiples count as 1 gravidity, term, preterm, or abortion, but count as the actual number in living children.
Pregnancy signs (presumptive)
Amenorrhea, nausea and vomiting, increased size and increased feeling of fullness in breasts, pronounced nipples, urinary frequency, fatigue, discoloration of the vaginal mucosa.
*The first perception of fetal movement may occur at the 16th to 20th week of gestation.
Pregnancy signs (probable)
Uterine enlargement;
Hegar’s sign: compressibility and softening of the lower uterine segment that occurs at about week 6.
Goodell’s sign: softening of the cervix that occurs at the beginning of the second month.
Chadwick’s sign: violet coloration of the mucous membranes of the cervix, vagina, and vulva that occurs at about week 6.
Ballottement: rebounding of the fetus against the examiner’s fingers on palpation.
Braxton Hicks contractions: irregular painless contractions that may occur intermittently throughout pregnancy.
Positive pregnancy test for determination of the presence of human chorionic gonadotropin.
Positive signs
Fetal heart rate detected by electronic device (doppler) at 10 to 12 weeks and by nonelectronic device (fetoscope) at 20 weeks of gestation.
Active movement palpable by examiner.
Outline of fetus vi radiography or ultrasonography.
Fundal height
Measured to evaluate the gestational age of the fetus.
During the second and third trimester (18 to 30 weeks), fundal height in cm approximately equals fetal age in weeks +- 2 cm.
At 16 weeks, the fundus can be found approx halfway between the symphysis pubis and the umbilicus.
At 20 to 22 weeks, the fundus is approx at the location of the umbilicus.
At 36 weeks, the fundus is at the xiphoid process.
Physiological Maternal Changes: Cardiovascular System
- Blood volume, plasma and red blood cell volume increases (total volume increases 40-50% approx).
- Physiological anemia occurs as the plasma increase exceeds the increase in production of red blood cells.
- Iron requirements are increased.
- Heart size increases, and is slightly elevated to left because of displacement of the diaphragm.
- Retention of sodium and water may occur.
- HR may increase 10-15 bpm, BP slightly decrease in second trimester and then increases in the third.
Physiological Maternal Changes: Respiratory System
- Oxygen consumption increases by approx 15-20%.
- Diaphragm is elevated because of the enlarged uterus.
- Shortness of breath may be experienced.
Physiological Maternal Changes: Gastrointestinal System
- Nausea and vomiting may occur as a result of the secretion of human chorionic gonadotropin (usually subsides by the third month).
- Poor appetite may occur due to decreased gastric motility.
- Alterations in taste and smell may occur.
- Constipation may occur because of an increase in progesterone production or pressure of the uterus resulting in decreased GI motility.
- Flatulence and heartburn may occur due to decreased GI motility and slowed emptying of stomach caused by an increase in progesterone production.
- Hemorrhoids may occur because of increased venous pressure.
- Gum tissue may become swollen and easily bleed, and ptyalism (excessive secretion of salive) may occur because of increased levels of estrogen.
Physiological Maternal Changes: Renal System
- Frequency of urination increases in the first and third trimester because of increased bladder sensitivity and pressure of the enlarging uterus.
- Decreased bladder tone may occur and is caused by an increase in progesterone and estrogen levels; bladder capacity increases in response to increasing levels of progesterone.
Physiological Maternal Changes: Endocrine System
- Basal metabolic rate and function increases.
- Anterior lobe of pituitary gland enlarges and produces serum prolactin needed for the lactation process.
- Posterior lobe of pituitary gland produces oxytocin, which stimulates uterine contractions.
- Thyroid enlarges slightly and activity increases.
- Parathyroid increases in size.
- Body weight increases.
- Water retention is increased.
Physiological Maternal Changes: Reproductive System
Uterus
- Enlarges (influence of estrogen)
- Size and number of blood vessels and lymphatics increase.
- Irregular contractions occur, typically begining after 16 weeks.
Physiological Maternal Changes: Reproductive System
Cervix
- Becomes shorter, more elastic, and larger in diameter.
- Endocervical glands secrete a thick mucous plug, which is expelled from the canal when dialation begins.
- Increased vascularization and estrogen cause softening and a violet discoloration known as Chadwick’s sign.
Physiological Maternal Changes: Reproductive System
Ovaries
- A major function of the ovaries is to secrete progesterone for the first 6 to 7 weeks of pregnancy.
- Maturation of new follicles is blocked.
- Ovaries cease ovum production.
Physiological Maternal Changes: Reproductive System
Vagina
- Hypertrophy and thickening of the muscle occur.
- An increase in vaginal secretions is experienced.
- Secretions are usually thick, white, and acidic.
Physiological Maternal Changes: Reproductive System
Breasts
- Changes occur due to increasing effects of estrogen and progesterone.
- Size increase and may be tender.
- Nipples become more pronounced.
- Areolae become darker in color.
- Superficial veins become proeminent.
- Hypertrophy of Montgomery’s follicles occurs.
- Colostrum may leak from the breast.
Physiological Maternal Changes: Skin
- Some changes occur because the levels of melanocyte-stimulating hormone increase as a result of and increase in estrogen and progesterone levels, including:
- increased pigmentation;
- dark streak down the midline of the abdomen (linea nigra);
- chloasma (mask of pregnancy);
- striae gravidarum on the abdomen, breasts, thighs, and upper arms.
- Vascular spider nevi may occur on the neck, chest, face, arms, and legs.
- Rate of hair growth may increase.
Physiological Maternal Changes: Musculoskeletal System
- changes in the center of gravity begin in the second trimester and are caused by the hormones relaxin and progesterone.
- lumbosacral curve increases.
- aching, numbness, and weakness may result.
- walking becomes more difficult and the woman develops a waddling gait and is at risk for falls.
- relaxation and increased mobility of pelvic joints occur, which permit enlargement of pelvic dimensions.
- abdominal wall stretches with loss of tone throughout pregnancy, regained postpartum.
- umbilicus flattens or protrudes.
Discomforts of Pregnancy: Nausea and Vomiting
- occurs in the first trimester and usually subsides by the third month.
- caused by elevated levels of human chorionic gonadotropin and other pregnancy hormones as well as changes in carbohydrate metabolism.
- interventions: eating dry crackers before arising; avoiding brushing teeth immediately after arising; eating small, frequent, low-fat meals during the day; drinking liquids between meals rather than at meals; taking antiemetic meds as prescribed.
Discomforts of Pregnancy: Syncope
- usually occurs in the first trimester; supine hypotension occurs particularly in the second and third trimester.
- May be triggered hormonally or caused by the increased blood volume, anemia, fatigue, sudden position changes, or lying supine.
- Interventions: sitting with the feet elevated and change positions slowly (risk for falls).
- Instruct to avoid lying in supine. Supine position places the woman at risk for supine hypotension, which occurs as a result of pressure of the uterus on the inferior vena cava.
Discomforts of Pregnancy: Urinary urgency and frequency
- usually occurs in the first and third trimesters.
- caused by pressure of the uterus on the bladder.
- interventions: drinking no less than 2L of fluid during the day; limiting fluid intake in the evening; voiding at regular intervals; sleeping side-lying at night; wearing perineal pads (if necessary); performing Kegel exercises.
Discomforts of Pregnancy: Breast tenderness
- can occur anytime throughout pregnancy.
- caused by increased levels of estrogen and progesterone.
- interventions: wearing a supportive bra, avoiding the use of soap on the nipples and areolar area to prevent drying skin.
Discomforts of Pregnancy: Increased vaginal discharge
- occurs anytime during pregnancy.
- caused by hypertrophy and thickening of the vaginal mucosa and increased mucus production.
- interventions: using proper cleansing and hygiene techniques; wearing cotton underwear; avoid douching.
Discomforts of Pregnancy: Nasal stuffiness
- occurs in the first through the third trimesters.
- results from increased estrogen, which causes edema of the nasal tissues and dryness.
- interventions: encouraging the use of a humidifier; avoiding the use of nasal sprays or antihistamines.
