The Pregnant Patient Flashcards
What should be commented on in the documentation of the breast exam (for all women)?
Symmetry
Tenderness
Masses
Skin Changes
Nipple Changes
Axillary lymph nodes
In the documentation for a pelvic exam what is a critical part to document?
Name and role of chaperone for pelvic exam
(for example: Assistant: Jane Smith, RN)
What is gravida?
A woman who is or has been pregnant (regardless of the outcome of the pregnancy)
What is nulligravida?
A woman who has never been pregnant and is not currently pregnant
What is primigravida?
A woman who is pregnant for the first time or has been pregnant once
What is multigravida?
An woman who has been pregnant more than once
What is nullipara?
A woman who has never given birth or never had a pregnancy beyond 20 weeks
What is primipara?
A woman who has given birth only 1 time (been delivered only once of a fetus/fetuses born alive or dead with a gestation of 20 or more weeks)
What is multipara?
A woman who has given birth 2 or more times (past 20 weeks)
What are some presumptive signs of pregnancy?
- Missed period or unusual bleeding pattern
- Nausea/vomiting
- Breast changes, size, tenderness, increased sensations
- Increased urinary frequency
What is Hegar’s sign?
Softening of uterine isthmus
What is Chadwick’s sign?
Bluish or cyanotic appearing cervix and upper vagina due to increased vascularity
What is Goodell’s sign?
Softening of cervix due to increased vascularity
What is Piskacek’s sign?
Asymmetric bulge or soft prominence of uterus caused by placental development
What are positive signs of pregnancy?
- Fetus identified by ultrasound
- Fetal heartbeat detected by doppler or ausculatation
- Objective detection of fetal movement
- Delivery of baby
What are some symptoms of early pregnancy?
Amenorrhea
Nausea/vomiting
Breast enlargement/tenderness
Fatigue
Urinary frequency
Pelvic discomfort/pressure
What will be seen on the uterus and cervix PE at 6+ weeks gestation?
Enlargement and softening of uterus
What will be seen on the uterus and cervix PE at 12 weeks gestation?
Uterus palpable above symphysis pubis in lower abdomen
What are some pregnancy skin findings typically seen in later pregnancy?
Melasma or Linea Nigra
What is the qualitative test to confirm pregnancy?
hCG
Does hCG (urine) have a high false negative rate?
Yes, usually due to testing too early
When is the best time to perform a hCG?
Early morning
Is serum hCG more sensitive than urine?
Yes
In typical pregnancies, what is the progression of hCG levels?
hCG levels double every 48-72 hours; increases every 96 hours as get further along
When do hCG levels usually peak?
8-11 weeks, then declines
What is the average pregnancy duration from first day of LMP?
280 days
What is Naegele’s rule in calculating due date?
Add 7 days to first day of LMP, then subtract 3 months, then add a year
When should the first prenatal visit be done, ideally?
First trimester, 8 to 10 weeks gestation
What should be done at the first prenatal visit?
- Confirm the pregnancy
- Determine estimated due date
- Desire for the pregnancy/attitude toward pregnancy
What is the recommended frequency of normal pregnancy prenatal care visits?
- Office visit at 8-10 weeks of pregnancy
- Every 4 weeks for first 28 weeks
- Every 2-3 weeks until 36 weeks
- Every week after 36 weeks
Should depression screening be completed at the first prenatal visit?
Yes, and almost every visit
What is the most important and critical vital sign during pregnancy?
Blood pressure, you can’t take it enough times
At 12 weeks the size of the uterus at what level of the abdomen?
Symphysis pubis
At 16 weeks the size of the uterus is at what level of the abdomen?
Halfway between pubis and umbilicus
At 20 weeks the size of the uterus is at what level of the abdomen?
Umbilicus
What is the single best prevention for neural tube defects?
Folic acid
What vaccines are indicated during pregnancy?
Tdap (every pregnancy)
Inactivated flu vaccine
What vaccines are contraindicated during pregnancy?
Live attenuated vaccines
MMR, Varicella, Zostavax, live attenuated flu
What vaccines should be delayed until after pregnancy?
Shingrix, HPV
A urine dip should be done at each visit to assess for what?
Protein and glucose
Infection (WBCs, nitrates)
After 36 weeks, the fetus moves into the pelvis, making what exam less reliable?
Fundal heights become less reliable after 36 weeks
When should screening for gestational diabetes occur?
Between 24 and 28 weeks
If the one hour glucose challenge test (1hr GTT) is positive what should be the next step to confirm the diagnosis of gestational diabetes?
3-hour glucose tolerance test (3hr GTT)
When should screening for group B beta-hemolytic streptococcus (GBS) be completed?
35-37 weeks
