Test Two Flashcards
What are the presumptive signs of pregnancy?
specific changes felt by the woman
- amenorrhea, fatigue, nausea/vomiting/breast changes, urinary frequency, fatigue, quickening
- Can be caused by reasons other than pregnancy, which is why it’s labeled as presumptive
What are the probable signs of pregnancy?
changes observed by the examiner
- Hegar sign (softening/compressibility of lower uterine segment), ballottement, pregnancy tests, Goodell sign, Chadwick sign, Braxton Hicks contractions, uterine soufflé
- can be other possible causes which is why it’s labeled probable
What are the positive signs of pregnancy?
signs that are attributable only to the presence of the fetus
-hearing fetal heart tones, visualization of the fetus, palpating fetal movements
What is the role and function of estrogen? What does it cause? What are its effects?
relaxes ligaments in chest wall increasing lung expansion, increases vascularity of upper respiratory tract (increased feelings of congestion),
- enlarges genitals, uterus, breasts and vasodilatation.
- relaxation of pelvic ligaments and joints, retention of Na and H2O by kidney tubules.
- Decreases hydrochloric acid and pepsin (~nausea during preg)
- cause selective increased vascularity and connective tissue proliferation (gums are spongy, swollen, bleed easily)
- Alters metabolism of nutrients by interfering with with folic acid metabolism, increasing the level of total body proteins and promoting retention of sodium and water by kidney tubules
What is the role and function of progesterone? What does it cause? What are its effects?
- Maintains pregnancy by relaxing smooth muscles, resulting in decreased uterine contractility and prevention of miscarriage
- responsible for increasing the sensitivity of the respiratory center receptors and an acid-base balance that pregnancy is a compensatory resp. alkalosis
- increased progesterone = decreased GI motility/constipation and “heartburn
- decreased tone and motility of smooth muscles, resulting in esophageal regurgitation, slower emptying time of the stomach and reverse peristalsis (heartburn or pyrosis)
- causes loss of muscle tone and decreased peristalsis resulting in an increase in water absorption from the colon leading to constipation
- Progesterone causes increase in cholesterol production, thickening of bile and decreased emptying time (gallstones)
Estrogen and progesterone together are responsible for…
- cause fat deposits in abdomen, back, and upper thighs
- are responsible for the increased sensitivity of the respiratory center to carbon dioxide
- change renal structure (renal pelves and ureters dilate and a larger volume of urine is held in the pelves and ureters and urine flow rate is slow resulting in urinary stasis, UIT, nocturia, etc)
What is the role and function of hcg? What does it cause? What are its effects?
is earliest biochemical marker for pregnancy; pregnancy tests are based on recognition of hCG or beta subunit of hCG, secreted by the placenta, detectable 7-10 days after conception
-High levels: may indicate abnormal gestation (e.g. Downs syndrome)
Low levels: slow increase or a decrease may indicate impending miscarriage
-maintains the production b the corpus luteum of estrogen and progesterone until the placenta takes over production
At 20 weeks where is the fundus?
The umbilicus!
Estrogen and Progesterone: How do they effect the respiratory adaptation of pregnancy?
Estrogen cause the ligaments of the rib cage to relax, increasing chest expansion
- Estrogen makes the upper respiratory tract become more vascular (as capillaries engorge, edema and hyperemia develop within the nose, pharynx, larynx, trachea, and bronchi leading to congestion, epistaxis, changes in voice, mild upper resp. infection
- Progesterone and estrogen: responsible for the increased sensitivity of the respiratory center to carbon dioxide (pregnant women become more aware of the need to breathe)
- Progesterone may be responsible for increasing the sensitivity of the respiratory center receptors (tidal volume increases, PCO2 decreases, and pH increases slightly) leading to compensatory respiratory alkalosis (these changes help transport carbon dioxide from fetus and oxygen release from the mother to the fetus)
Estrogen and Progesterone:
How do they effect renal adaptation of pregnancy
- Changes in renal structure, renal pelves and ureters dilate, increased GFR and RPF (renal plasma flow)
- estrogen alters metabolism of nutrients by interfering with folic acid metabolism, increase the total body proteins, and promoting the retention of sodium and water by the kidney tubles
- Estrogen can make gums hyperemic, swollen, and bleed easily
What is the mechanism that causes the mild peripheral edema?
- 500-900 mEq of sodium is retained to meet fetal needs. Because of the need for increased fluid volume (for mom and baby), additional sodium is needed to expand fluid volume and maintain an isotonic state
- Kidneys can excrete water during the early weeks of pregnancy more efficiently than later in pregnancy. The pooling of fluid in the legs in the latter part of pregnancy decreases renal blood flow and GFR (requires no treatment).
What causes the nausea?
possibly in response to high hCG
-estrogen may decrease secretion of hydrochloric acid and pepsin (which may be responsible for digestive upsets such as nausea)
How does estrogen and progesterone effect GI system (constipations, etc)?
decreased hCl acid (leading to peptic ulcer formation, nausea), decreased tone and motility of smooth muscles resulting in esophageal regurgitation, slower emptying time of the stomach, and reverse peristalsis (heartburn aka pyrosis), increase in water absorption from the colon and may cause constipation,slight hypercholesterolemia may lead to gallstones
Why does the center of gravity change?
Abdominal distention gives the pelvis a forward tilt, decreased abdominal muscle tone, and increased weight bearing cause realignment of the spinal curvature late in pregnancy and move the woman’s center of gravity forward
-An increase in the cure of the back (lordosis) develops, and exaggerated anterior flexion of the head develops to help her maintain her balance
Why does she waddle? What does estrogen and progesterone do to the joints
Walking is more difficult with the center of gravity shift
- the ligamentous and muscular structures of the middle and lower spine may be severely stressed
- Estrogen and relaxin hormones relax and soften the body, enlarged pelvic dimensions, separation of the symphysis pubis and instability of the sacroiliac joints may cause pain and difficulty in walking
What are some of the psychosocial things mom and dad go through to adapt to pregnancy?
Mother: accepting the pregnancy, identifying with the role of mother, reorder the relationships between herself and her mother and between herself and her partner, establishing a relationship with the unborn child, and preparing for the birth experience
Father: accepting the pregnancy (announcement phase, moratorium phase, and the focusing phase), identifying with the father role, reordering personal relationships, establishing a relationship with the fetus, and preparing for childbirth
What is couvde syndrome?
men who experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symtoms
What are the normal lab tests you would do prenatally?
H&H, WBC, blood type, Rh, Rubella titer, TB, UA, BUN, creatinine, electrolytes, total protein excretion, pap test, vaginal smear for gonorrhea, chlamydia, HPV, GBS, HIV, hep B, MSAFP/Quad-screen, glucose tolerance tests, ECG, chest x-ray, and echo
Would you give a pregnant woman a live vaccine?
No
What are some variations of adolescent pregnant mothers?
- much less likely than older women to receive adequate prenatal care, more likely to smoke and less likely to gain adequate weight during pregnancy, increased risk of LBW, serious and long-term disability, and of dying during the first year of life
- delayed prenatal care can result in late recognition of pregnancy, denial of pregnancy, or confusion about the available services, inadequate time before birth to attend to correctable problems, higher risk for conditions associated with first pregnancy regardless of age (gestational hypertension)
What are some variations of older pregnant mothers?
- Multiparous women: some have never used contraceptives and some have used them but stop as menopause approaches and become pregnant
- Primiparous: often successfully established in a career and lifestyle with a partner with time for self-attention
- partners seem to share the preparation for parenthood and plan a family-centered birth, women seek lots of information, adverse perinatal outcomes are more common in older primiparas even with good prenatal care (LBW, premature birth, and multiparas), increased risk of maternal mortality (hemorrhage, infection, embolisms, HTN disorders, cardiomyopathy, and strokes)
What are some nutritional needs during pregnancy?
Energy needs, weight gain, protein, fluids, fiber, calcium, iron, zinc, iodine, magnesium, vitamin A, D, E, C, folate and B6, B12, grain products, vegetables, fruits, milk and milk products, meats, nuts, eggs
What are some specific vitamin needs during pregnancy and why?
Iron Calcium Sodium Zinc Fluoride Fat-soluble vitamins Water-soluble vitamins Multivitamin-multimineral supplements during pregnancy
What are some things they should avoid pregnancy?
caffeine, alcohol, smoking, high levels of mercury in fish
What is important to know when doing an OB history?
age at menarche, menstrual history, contraceptive history, nature of any infertility or gynecologic conditions, STI history, sexual history, detailed history of all pregnancies and outcomes, date of last Pap test and result, LMP
What would you ask mom about diet, exercise?
Did you exercise before pregnancy?
Dietary behaviors, preferences, cravings, what herbs, supplements, allergies, etc
If no medical or OB problems preg. women should perform 30 minutes of moderate physical exercise/day
-Drink enough fluid before, during, and after exercise (dehydration can trigger premature labor), and calorie intake should be sufficient to meet the increased needs of pregnancy and demands of exercise
What are some adolescent pregnancy nutritional needs?
choose a weight fain goal at the upper end of the range for their BMI, improving the nutrition knowledge, meal planning, food preparation, promote prenatal care, develop nutrition interventions, and strive to understand the factors that create barriers
What are the 5 P’s of labor?
Read study guide for more in depth on 5 Ps**
- Passenger (fetus and placenta)
- Passageway (birth canal)
- Powers (contractions)
- Position of the mother
- Psychologic response
What is the Ferguson reflex?
The urge to bear down (when the presenting part of the fetus reaches the perineal floor)
What are the 3 phases in the first stage of labor?
1st stage of labor: onset of regular uterine contractions to full dilation of the cervix -1-20 hours long Latent Phase: 0-3 cm dilated Active Phase: 4-7 cm dilated Transitional: 8-10 cm dilated
Describe the 2nd stage of labor
lasts from the time the cervix is fully dilated to the birth of the fetus. Average of 20 minutes for multiparous woman 50 minutes for a nulliparous woman
Describe the 3rd stage of labor
birth of the fetus until the placenta is delivered, 3-30 minutes, the risk of hemorrhage increases as the length of the third stage increases
Describe the 4th stage of labor
about 2 hours after delivery of placenta, period of immediate recovery, when homeostasis is reestablished, an important period of observation for complications, such as abnormal bleeding
What are the mechanisms of labor?
(watch a video to understand*) The 7 cardinal movements that occur in a vertex presentation are:
engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and birth by expulsion
What’s the most important thing for extra-uterine life of the infant?
First breath of oxygen
-pressure from birth, PO2 decreases, PCO2 increases, arterial pH decreases, bicarb decreases, fetal respirator movements decrease during labor
these changes stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for initiating respirations immediately after birth
Continuous lumbar epidural
C/s or vag pain relief by injecting local anesthetic (bupivacaine, ropivacaine), an opioid analgesic (fentanyl, sufentanil) or both into the epidural space
-the opioid combo with anesthetic reduces the does of anesthetic required
Where are epidurals inserted?
between the 4th and 5th lumbar vertebrae
How is continuous block achieved?
by using a pump to infuse the anesthetic solution through an indwelling plastic catheter
What are the advantages of an epidural block?
woman is alert, comfortable, able to participate, airway intact, gastric emptying is not delayed, blood loss is not excessive, the dose can be modified to allow the woman to push and to assume upright positions and even to walk
What are the disadvantages of epidural block?
control is limited, orthostatic hypotension,sedation, leg weakness, CNS effects if accidentally injected into blood vessel, too high of a dose leads to respiratory arrest, higher rate of fever, severe hypotension can result in significant decrease in uteroplacental perfusion and oxygen delivery to fetus, urinary retention, stress incontinence, pruritus,longer second-stage labor, for some women it is not effective
Review the process of maternal hypothermia with analgesia, what is that process?
- Defined as core body temperature of less than 35° C (95F)
- Caused by effects of analgesia and anesthesia
- May result in cardiovascular, pulmonary, circulatory, hematologic, neurologic, or renal complications
What is the purpose of amniotic fluid?
maintains temperature, cushions the baby, allows freedom of movement, helps the build muscle strength, source of oral fluid and waste, kepps fetus from tangling with the membranes
-800-1200mL present at term
Having less than 300 mL of amniotic fluid is called _____ and is associated with _____
oligohydramnios
-fetal renal abnormalities
Having more than 2L of amniotic fluid is called ____ and is associated with _______
hydraminos
-gastrointestinal and other malformations
What is the function of the yolk sac?
aids in transferring maternal nutrients and oxygen, which have diffused through the chorion, to the embryo
- blood vessels form to aid transport
- help transfer oxygen and nutrients before placenta is established
- During the 4th week the yolk sac incorporates into the embryo’s body as the primitive digestive sstem
What is the function of the umbilical cord?
-to transfer blood to and from baby
-formed by the 5th week, at term the corn is 2cm diameter and 30-90 cm long
-Wharton jelly: prevents compression of the blood vessels and ensures continued nourishment of the embryo or fetus
Nuchal cord: when the cord is wrapped around the fetal neck
What is unique about umbilical cord arteries and veins?
Arteries carry deoxygenated blood and veins carry oxygenated blood (reverse of normal arteries and veins)
What is the function of the placenta?
the placenta functions as a means of metabolic exchange (respiration, nutrition, excretion, and storage)
- functions as endocrine gland (hCG, hCS/hPL, progesterone, estrogen)
- stores carbs, proteins, calcium, and iron for ready access to meet fetal needs
What does hCG do?
preserves the function of the ovarian corpus luteum, ensuring a continuous supply of estrogen and progesterone needed to maintain the pregnancy
What does hCS/hPL do?
similar to a growth hormone, stimulates maternal metabolism to supply needed nutrients for fetal growth
-increases resistance to insulin, facilitates glucose transport across placental membrane, and stimulates breast development to prepare for lactation)
What does progesterone do? (combine with earlier card)
maintains the endometrium, decreases the contractility of the uterus, and stimulates maternal metabolism and development of breast alveoli
What does estrogen do? (combine with earlier card)
stimulates uterine growth and uteroplacental blood flow, causes proliferation of the breast glandular tissue and stimulates myometrial contractility
What is placenta accreta, increta, and percreta?
unusual placental adherence
accreta: slight penetration of myometrium by placental trophoblast
increta: deep penetration of myometrium by placenta
percreta: perforation of uterus by placenta
- Bleeding with occur when removal of placenta occurs
- hysterectomy is indicated in 2/3 of women
What is placenta previa?
Previa: the placenta is implanted in the lower uterine segment where is comletely or partially covers the cervix, or is close enough to the cervic to cause bleeding when the cervix dilates or the lower uterine segment effaces
What are the major causes of bleeding in late pregnancy?
placenta previa and premature separation of the placenta (placental abruption)
What is vasa previa?
blood vessels in the amniotic sac, if the sac ruptures on the vessel you can bleed out
-associated with placenta previa and multiple gestation
What’s the most common and fastest growing bacterial STI?
Chlamydia
-Infections often silent and highly destructive
Difficult to diagnose
IUD is a higher risk for ________
pelvic inflammatory disease
If mom has Hep B, what do we do for baby?
Give 2 vaccines within 12 hours, if not 90% chance baby will be infected
What is the leading cause of maternal death?
Hemorrhage
Alphafetal protein: what if it’s too high? Too low?
High: Increased risk of neural tube defect
Low: could be increased risk for Down’s but need further testing
What does TORCH stand for?
T: toxoplasmosis O: other (hepatitis A, B, syphilis, varicella zoster, parvovirus B19, Coxsackie Virus) R: rubella virus C: cytomegalovirus H: herpes simplex virus
What do torch infections do to mom and baby?
- Capable of crossing placenta and adversely affecting development of fetus
- Produce influenza-like symptoms in mother
- Fetal and neonatal effects are more serious
Women seeking birth control but has multiple partners you would not recommend… why?
Not recommend an IUD because it is still risk for infection and there is no barrier
Describe pelvic inflammatory disease:
- Single most frequent serious infection encountered by women
- Bacterial infection (multiple kinds can do this) and spread out to other areas (fallopian tube) leading to inflammation, pain, scar tissue, etc
- most common causes are gonorrhea and Chlamydia
- Results from ascending spread of microorganisms from the vagina and endocervix to the upper genital tract
- More severe in women infected with HIV
- increased risk for extopic pregnancy, infertility, chronic pelvic pain
What is the single most frequent serious infection encountered by women?
Pelvic inflammatory disease
Chlamydia can lead to.. if untreated
Can lead to pelvic inflammatory disease (inflamed fallopian tube leading to scar tissue) and lead to ectopic pregnancy or flow out into abdominal cavity and implant or lead to infertility
What is the most common cause of perinatal death?
congenital anomalies
Review basic cultural factors, what makes them high risk?
Lack of health insurance Teen pregnancy Substance abuse Consequences of inadequate prenatal care Nutritional deficits
Intimate partner violence may be acts of: (4)
Physical
Sexual
Psychological
Economic
What are the 3 phases of violence against women?
Repeated cycles of these 3 phases:
Phase 1 – Increasing Tension, anger, blaming, arguing
Phase 2 – Battering; hitting, choking, use of weapons or sexual abuse. Verbal threats
Phase 3 – Calm stage; blame ETOH, apologize, promises. Stage becomes shorter over time
What does a SART physical exam consist of?
Physical examination: Pelvic examination Vaginal examination Bimanual palpation Rectovaginal palpation
What are the 4 causes of post partum psychologic complications?
Biologic Psychologic Situational Multifactorial Cultural practices may have positive or negative effect
Postpatum depression with psychosis is most often characterized by ______, _____, and __________.
depression, delusions, and thought by the mother of harming either the infant or herself
When do symptoms of postpatrum depression with psychotic features begin?
can begin within days after the birth, most often 2-3 weeks after birth, and almost always within 8 weeks of birth
What are some early signs of post partum depression with psychosis?
fatigue, insomnia, restlessness, episodes of tearfulness and emotion lability. Complaints regarding the inability to move, stand, or work
A specific illness included in depression with psychotic features is _______
bipolar disorder Manic episodes for at least 1 week Grandiosity Decreased need for sleep Pressured speech Flight of ideas No regard for negative consequences May be to preoccupied to care for newborn
What is the difference between PPD and postpaturm psychosis?
PPD mood disorder without psychotic features
Postpatrum psychosis: with psychotic features
-both usually occur within 4 weeks of childbirth
What are the treatment options for PPD?
There is usually gradual improvement over the 6 months after birth. Supportive treatment alone is not effective for major PPD and pharm. is needed.
- Antidepressants, anxiolytic agents, and electroconvulsive therapy
- Psychotherapy focuses fears and concerns of new responsibilities and roles, and monitoring for suicidal or homicidal thoughts
What are the treatment options for postpartum psychosis?
Psychiatric emergency; may require psychiatric hospitalization
Antipsychotics and mood stabilizers such as lithium are the treatments of choice
Perinatal loss, what is the most important thing you can provide in perinatal loss?
Support
presence, listening, create a memory box, treat the baby with same care (bathing etc)
What is the purpose of maintaining a pregnancy (one with a very grim outcome)?
hope
What is a biophysical profile (BPP)?
Noninvasive assessment of the fetus and its environment using ultrasonography and fetal monitoring
- dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease
- Combination of NST and Ultrasound Exam
What does a BPP include?
includes fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate (determines by means of NST), and qualitative amniotic fluid volume (AFV)
What is amniocentesis? Why is it performed?
a needle is inserted into the uterus under direct ultrasound visualization
-obtains fluid with fetal cells to detect genetic disorders, congenital anomalies, pulmonary maturity, and diagnosis of fetal hemolytic disease
What are the complications of amniocentesis the mother and fetus can experience
Maternal: hemorrhage, fetomaternal hemorrhage with possible maternal Rh isoimmunization, infection, labor, abrupto placentae, inadvertent damage to the intestines or bladder, and amniotic fluid embolism
Fetal: death, hemorrhage, infection (amnionitis), direct injury from the needle, miscarriage or preterm labor, and leakage of amniotic fluid
Describe a NST
noninvasive and has no contraindications
- evaluation of fetal response (FHR) to natural contractile uterine activity or to an increase in fetal activity
- uses FHR monitor and toco
- the basis is that the normal fetus will produce characteristic heart rate patterns in response to fetal movement
- Reactive result: 2 accelerations in a 20 minute period
- Nonreactive result: does not produce two or more qualifying accelerations in a 20 minute period
What are the indications for a NST and the Contraction Stress Test?
- Maternal DM
- Chronic hypertension
- Hypertensive disorders in pregnancy
- IUGR
- Sickle cell disease
- MAternal cyanotic heart disease
- Postmaturity
- History of previous still birth
- Decreased fetal movement
- Isoimmunization
- Hyperthryoidism
- Collagen disease
- Chronic renal disease
Describe a Contraction stress test (CST or OCT [oxtocin challenge test])
test to stimulate uterine contractions for the purpose of assessing fetal response; a healthy fetus does not react to contractions, whereas a compromised fetus demonstrates late decelerations in the fetal heart rate that are indicative of uteroplacental insufficiency
What are the pros and cons of CST vs NST?
CST provides an earlier warning of fetal compromise than the NST with fewer false positive results
CST more time consuming and expensive than NST, also is invasive if oxytocin is required
The uterus rises gradually to the level of the umbilicus at about _______ of gestation and nearly reaches the _____ at term. Between weeks _____, fundal height drops as the fetus begins to descend and engage in the pelvis (aka_______)
- Umbilicus at 22 weeks
- Xiphoid process
- 38-40 weeks
- Lightening
What does GTPAL stand for? G/P?
Gravidity (pregnancies) Term Births Preterm Births Abortions and Miscarriages Living Children G/P: gravidity and parity (pregnancies that have reached 20+weeks)
From approximately gestational weeks 18-32, the hight of the fundus in cm is …
approximately the same as the number of weeks of gestation (plus of minus 2), with an empty bladder at the time of measurement
What are some factors that put a pregnant mom at risk for poor nutrition?
multiple pregnancies close together, diabetes, age (younger than 20, over 35), poor nutrient intake
-poverty, use of tobacco, alcohol, or drugs, problems with weight gain, multifetal pregnancy, low H&H
What is Folate’s role in relation to pregnancy and lactation?
prevention of neural tube defects, support for increased maternal RBC formation
What are the live virus vaccines contraindicated in pregnancy? (4)
measles (rubeola and rubella), chickenpox, mumps and poliomyelitis
Which vaccines can be administered during pregnancy? (killed viruses) (4)
Tetanus, diphtheria, hep B, and flu shot
What are the initial lab tests in the prenatal period?
H&H, CBC, blood type, Rh, Rubella titer, TB, UA, renal function tests (BUN, creatinine, etc) Pap, vaginal smear, syphilis (RPR, VDRL, or FTA=ABS) HIV, hep B, MSAFP/Quad screen, glucose tolerance, cardiac (ECG, chest X-ray, echo)
Risks with lumbar epidural:
low bp, high temperature, urine retention, aspiration, itching, limited movement, HA, metallic taste, tinnitus, slurred speech, convulsions, longer second stage labor, increased use of oxytocin, increased likelihood of forcepts or vacuum-assisted birth
Differentiate between a spinal and an epidural analgesia/anesthesia
Spinal: injects into 3, 4, or 5th lumbar space into the subarachnoid space (mixes with CSF)
-more common in c/s
Epidural: injected into epidural (peridural space) between the 4th and 5th lumbar vertebrae
What is the combined spinal-epidural analgesia
blocks pain without compromising motor ability
side effects:pruritus and nausea, fetal bradycardia
-allows women to change positions easier and sit upright during birth
What is a family theory?
can be used to describe families and how the family unit responds to events both within and outside the family
-makes certain assumptions about the family and has inherent strengths and limitations.
Identify maternal and family tasks and emotional adaptations required with pregnancy and parenting
reaction to newborn cues, react positively to the newborn, providing comfort, providing care, attachment, bonding
Placenta functions as a ____ gland, producing _______
endocrine gland, producing hCG, hCS/hPL, progesterone, estrogen
Daily fetal kick count
count once a day for 60 minutes
-fewer than 3 fetal movements within one hour warrants further evaluation by NST or CST, or BPP
TORCH diseases can all _______
cross the placenta
Family systems theory
- Describes an interactional model. Any change in one member will create change in others
- Change in any family member will affect other members of the family.
- The interactions are considered to be the problem, not the individual family members
- Focuses on the number of dyad interactions that can occur
What does the O in TORCH stand for?
hepatitis A, B, syphilis, varicella zoster, parvovirus B19, Coxsackie Virus
What is Chadwick’s sign?
the blue-violet coloring of the cervix caused by increased vascularity; this occurs around the fourth week of gestation.
What is Goodell’s sign?
Softening of the cervical tip, which may be observed around the sixth week of pregnancy.
What is Hegar’s sign?
At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur
