Unit 2 Flashcards
What percentage of pregnancies are planned in the US?
50%
How much folic acid should all women of reproductive age take?
400µg folic acid daily
Gravidity
Number of pregnancies, regardless of outcome
Parity
number of pregnancies carried to 20 weeks (this number may vary by region)
Term
of pregnancies* that ended at 37 weeks or beyond
Preterm
of pregnancies* ending between 20 and 36 weeks 6 days
Abortion
of pregnancies* ending prior to 20 weeks (may be further split into “spontaneous” and “induced”). Stillbirths are not included
Living Children
of children alive at time of recording
EDD
estimated due date
Naegele’s rule
Take first day of Last Menstrual Period, subtract 3 months from the date and add 7 days.
When should ultrasound measurements be taken to accurately measure due dates
20 weeks
Physicians
May be Obstetrician (generalist or high-risk perinatologist) or Family Practice.
Able to perform cesarean deliveries, operative vaginal births, and complex repairs.
Midwives
May be Nurse Midwife or Lay midwife
Cannot perform cesarean deliveries or complex repairs
Midwife births tend to have fewer interventions
Doulas
Birth support, not responsible for the birth itself but for anticipating and responding to a family’s nonmedical needs
Provide emotional, physical, and informational support
Tests to obtain for pregnant women
- CBC
- Blood Type
- VDRL (screening for syphilis)
- TB screening
- Hepatitis B screen
- HIV screen
- Urinalysis
- Pap Test
- Maternal serum alpha protein, hCG level, Inhibin A, and nuchal lucency
Glucose Challenge Test done..
24-26 weeks, 1 hour GCT done, if elevated, 3 hour done
Each visit includes:
- VS
- Weight
- Urine
- Fundal height
Wt. gain in first trimester
1.1-4.4 lb
Wt. gain in second trimester
majority of the weight is gained in this trimester
Third Trimester wt. gain
weight gain should slow down. Large swings in weekly weight gain can indicate fluid retention
Nutritional education for pregnant women
- Start taking a prenatal vitamin if not already doing so; include DHA Omega-3 fatty acid)
- Increase carbohydrate in 45g daily above nonpregnant needs
- Increase protein in 25-30g daily above nonpregnant needs
Caloric intake in pregnant women
First Trimester: no change needed
Second Trimester: increase in 340kcal above nonpregnant needs
Third trimester: increase in 452 kcal above nonpregnant needs
Nutrient needs of pregnant women
- Water soluble vitamins (B6, B12, C, folic acid, riboflavin, thiamine and niacin) are not stored by the body and should be included in the daily diet.
- The pregnant woman needs 27mg of iron daily (increase from 18mg).
- Calcium
What food should be avoided by pregnant women?
- Raw fish
- Raw eggs
- Deli meat
- Unpasteurized juices
- Raw sprouts
- Unwashed fruits and vegetables
- Undercooked meats
- Alcohol
- Specific meds
Pica
- cravings for nonnutritive substances such as ice, clay or dirt.
- Often associated with iron-deficiency anemia or other nutritional deficiencies
Harmful Substances
- Smoking
- Caffeine
- Alcohol
- Drugs
Pain relief during labor
Epidural Anesthesia
IV narcotics
Natural pain relief methods such as HynoBirthing, patterned breathing, essential oils and hydrotherapy
Prepregnant uterus wt. and capacity
70g with a capacity of 10ml
38-42 weeks uterus wt. and capacity
1100-1200g and has a capacity of 5 L
Braxton Hicks Contractions
irregular, painless contractions with intermittent tightening and relaxation
Hegar’s sign
Softening of the isthmus (lower portion) of the uterus
Changes of cervix in pregnancy
- Most obvious change is in consistency and color
- Increasing levels of estrogen cause hyperemia (congestion of blood)
Chadwick’s sign
bluish-purple color that extends to include the vagina and labia, one of the earliest signs of pregnancy
Goodell’s sign
After conception, the cervix feels soft more like the lips or earlobes
Operculum
mucous plug in the cervix that creates a barrier against outside pathogens
Vagina and Vulva changes in pregnancy
More vascularity gives it the same bluish color
Softening of the connective tissue allows it to distend during birth.
Leukorrhea of pregnancy
- White, thick discharge, may be copious
- Should not smell foul or fishy
Progesterone purpose
- must be present in adequate amounts for a healthy pregnancy in the earliest stages.
- Progesterone suppresses contractions of the uterus that would reject the fetus.
Colostrum is secreted when?
early as 16 weeks
How common is a systolic murmur in pregnancy?
90% of women have it
How common is a third heart sound in pregnancy?
80% of women have it
Cardiovascular changes in pregnant women
- Myocardium increases in size
- Total Blood Volume increases
- Plasma increases
- Diluted Hgb/Hct
- Increase in cardiac output
- Increase in heart rate
- Systemic vascular resistance drops during pregnancy
Blood pressure and blood flow changes in pregnant women
- Diastolic blood pressure drops slightly, 10-15mmHg
- Supine hypotension in late pregnancy
- Increase in WBC
- Hypercoagulable state
- Renal plasma flow increases by 30% to remove more metabolic waste
- Blood pools in lower extremities as the uterus obstructs the inferior vena cava and the iliac veins
Respiratory System changes in pregnant women
- Oxygen consumption increases 15-20% in pregnancy
- Increased tidal volume
- As the uterus grows, the diaphragm is elevated leading to rib cage expansion
GI System changes in pregnant women
- Unless the woman is nauseated the appetite increases. Food intake may increase 15-20% in early pregnancy
- gingivitis and bleeding gums called epulis, which regresses after birth
- ptyalism
- Esophageal sphincter tone decreases causing heartburn
- constipation
- Liver is pushed up and alkaline phosphate levels are 2-4 times higher
- Emptying time of gallbladder is slowed predisposing to gallstones.
ptyalism
excess saliva
Urinary System changes in pregnant women
- Increased frequency and urgency is normal in pregnancy
- Bladder capacity doubles by term, tone decreases due to progesterone.
- Nocturia is common
- Kidneys increase in size and change shape
- GFR increases by up to 50%, glucose excretion increases and glycosuria is common.
- Urine output is increased, mild proteinuria can be common in pregnancy.
- Increased risk for UTIs starting in week 6 through week 24 because of changes in the urinary tract
Skin, Hair, Nails changes in pregnant women
- Increased circulation to skin helps to dissipate more heat produced by increased metabolism.
- Increase in blood vessel dilation causes angiomas, redness of palms and soles of feet known as palmar erythema.
- Striae gravidarum
- Hair grows more rapidly and less falls out, nails become more brittle
melasma, chloasma, or “mask of pregnancy”
Hyperpigmentation on cheeks, forehead or the bridge of the nose.
Linea alba
longitudinal line marking the middle of the abdomen, darkens to become the linea nigra. It usually disappears after pregnancy.
Musculoskeletal changes in pregnant women
- lordosis
- round ligament pain
- diastasis recti
Diastasis Recti
abdominal muscles separate
Normal Discomforts of Pregnancy
- Fatigue
- Dyspnea
- Orthostatic hypotension
- Supine Hypotension
- Edema
- Varicosities
- Varicose veins, vulvar varicosities, or hemorrhoids
- Headaches
- Breast tenderness and leaking
- Urinary frequency and stress incontinence
- Nausea and vomiting (Usually stops at end of 1st trimester)
- Food aversions or cravings
- Heartburn
- Constipation
- Acne, pigmentation changes, and dry skin
Preeclampsia
Edema that arises suddenly, particularly with other symptoms such as blurred vision, epigastric pain, or headache
Presumptive Symptoms of Pregnancy
- Amenorrhea
- Nausea
- Fatigue
- Urinary frequency
- Breast tenderness or enlargement
Probable Signs of Pregnancy
- Positive hCG pregnancy test
- Abdominal enlargement
- Goodell’s sign
- Hegar’s sign
- Chadwick’s sign
- Ballottement
-Braxton Hicks Contractions
Ballottement
Palpation of fetal outline
Positive Signs of Pregnancy
- Auscultation of fetal heart sounds on Doppler
- Fetal movement palpated by an examiner
- Ultrasound visualization of pregnancy
