Unit 2 Pregnancy/Antepartum Flashcards
What does TPAL stand for?
Term babies
Premature babies
Aborted babies
Living Children
What are Presumptive Pregnancy Signs?
Breast Changes Amenorrhea (without period) Nausea Vomitting Urinary Frequency Elevation of BBT Fatigue Quickening
What are Probable Pregnancy Signs?
Goodell's Sign Chadwick's Sign Hegar's Sign Positive Pregnancy Test Uterine enlargement Uterine souffle Braxton Hicks contractions Ballottement
What is Goodell’s Sign?
Cervix becomes soft
What is Chadwick’s Sign?
Deep bluish purple color in uterus/cervix.
What is Hegar’s Sign?
Distinct feeling of upper & lower area in uterus
What is Uterine souffle?
Pulse rate in the uterus that equals woman’s heart
What are Braxton Hick’s?
8th or 9th month practice contractions
What is Ballottement?
Embryo bounces up when two fingers are taped into uterus.
What are Positive signs of pregnancy?
Visualization of fetus by ultrasound
Fetal heart tones detected by ultrasound examination
Fetal movements palpated
Fetal movements visible
Bigger weight babies usually come from whom?
Diabetics
Blood Volume is increased by how much during pregnancy?
30-50%
Getting pregnant just getting off birth control can cause what?
Twinning effect
At the following weeks where should the fundus be?
10-12 weeks 16 weeks 20 weeks 28 weeks 36 weeks
10-12: slightly above symphysis
16 weeks: halfway between symphysis and umbilicus
20 weeks: at umbilicus
28 weeks: three finger breaths above umbilicus
36 weeks: just below ensiform cartilage (xyphoid process)
What is the fundus?
top of the uterus
Because of the increased blood volume during pregnancy what do you want to promote and why?
Hydration to prevent premature labor and dehydration.
A measurement from the top of the symphysis pubis to the top of the fundus suggests what?
Weeks of gestations,
Ex: 28cm would be 28 weeks.
Describe fetal heartbeat at the following weeks:
10-12 weeks
17-20 weeks
20 weeks
10-12: heard with a doppler
17-20: heard with a stethoscope
20: can palpate fetal movements (20 weeks is known at period of viability for fetus)
What is the fetal HR?
120-160
When can quickening be felt?
Around 20 weeks
What is the optimal pelvis for pregnancy?
Gynecoid (heart shaped)
What is done during pelvic exam?
- External and internal genitals evaluated
- Pap obtained
- Gonorrhea culture and chlamydia screen
- Chadwick’s and Goodell’s Sign
- Uterine size evaluated if appropriate for length of gestation
What is the purpose of an initial assessment during pregnancy?
To evaluate the mother for and complication from a possibility of issues such as:
- Diabetes ( bigger babies )
- Smoking (premature babies)
- High blood pressure
- Breast cancer
- Cardiovascular disease
- etc
How is pregnancy due date calculated?
FIRST day of the woman’s last menstrual period, count back 3 months and add 7 days.
(Pregnancy last 40 weeks/9 months)
At birth babies lose what percent of their body weight?
10%
What are premature babies especially at risk for because of their low birth weight?
Neurological defects
How many weeks is considered early premature? late premature? term? postmature?
Early premature- 21 weeks-33 weeks
Late premature- 34-37 weeks
Term- 38-40 weeks
Postmature- 41-43 weeks
What does viability mean?
Ability to survive
Regarding term babies (38-40 weeks) what are the different size categories and weights associated with them?
LGA (Large for Gestational Age) >8 lbs.
SGA (Small for Gestational Age) <5 lbs.
AGA (Appropriate for Gestational Age) 6.5-8 lbs
What should the frequency of prenatal visits be?
Every 4 weeks for the first 28
Every 2 weeks to 36
Every week there after until birth
What should the weight gain be for women during pregnancy?
3.5-5 lbs for the first three months then 1 lbs per week
If Hgb is low, around 8-10, what would be an appropriate intervention?
Fluids and Iron
What cardiac issues could older mothers experience in labor?
MI and cerebral bleeds
When are MSAFP (Maternal serum alpha fetal protein) be taken and what do low or high levels result in?
Between 15-22 weeks
Low levels result in Down Syndrome
High levels result in Neural tube(spinal cord) defects
In the first trimester what are signs of POTENTIAL complication and what do the complications refer too?
Severe vomiting- Hyperemesis gravidarum(Condition of severe vomiting)
Chills, fever, burning on urination- Infection
Abdominal cramping and vaginal bleeding- Miscarriage
In the second and third trimester what are signs of POTENTIAL complications and what do they refer too?
Sudden discharge of vaginal fluid- Premature Rupture of Membrane
Glycosuria- Gestational diabetes
Vaginal bleeding/severe abdominal pain- Placenta previa or abruption or miscarriage
Severe backache or flank pain- Kidney infection or stones
Change in fetal movements- Intrauterine fetal death
Visual disturbances, swelling of face, headaches, muscular irritability, epigastric pain—-Hypertensive
conditions:
preeclampsia or eclampsia
Describe briefly life in the trimesters.
First trimester primary organ development happens, open for insult by teratogens
Second trimester- morning sickness passes and quickening occurs
Third trimester- increasing weight and physical and psychological changes
What is considered the pacemaker of the uterus?
the fundus
What is the fundus referred to after delivery?
FF@U
Fundus Firm At Umbilicus
Describe the cervix is pregnancy.
- feels like cartilage in your nose, softens and shortens to feel like the lobe of your ear
- the softening is known as Goodell’s Sign and the increased blood flow as Chadwick’s Sign (blue in color)
- Mucous plug is formed and acts as a barrier to ascending infection
- Cervix in labor will dilate the width of five fingers or ten centimeters (each finger tip is equal to 2 cm.)
Describe the breasts during pregnancy.
- Based on pigmentation: nipples darken
- Breasts enlarge
- Colostrum(first milk) production produced by week 12 as preparation for breast feeding
- Colostrum is the precursor of human milk and contains newborns immunity base
Describe the respiratory system during pregnancy.
Hyperventilation increases
Tidal volume increases
Diaphragm is elevated
Breathing changes to thoracic
What simple intervention associated with blood volume can help stop premature labor?
hydration
Describe the cardiovascular system during pregnancy.
- By 20-24 weeks cardiac output increases 30 to 50 percent
- Pulse rate increases
- Blood pressure slightly decreases by second trimester and is near pre-pregnant levels at term
-WBC level increases to 11,000-12,000, during labor even up to 25,000
What is vena cava syndrome or supine hypotensive syndrome and how is it corrected?
Pressure of enlarging uterus blocks blood return to the heart and causes fainting
Place woman on side, or lie with a wedge under right hip
Describe the gastrointestinal system in pregnancy.
- Nausea is common, vomiting occasionally
- Ptysalism (excessive salivation)
- Intestines and stomach displaced by uterus
- Relaxed cardiac sphincter leads to heartburn
- Delayed gastric emptying leads to constipation
- Hemorrhoids
Try to think obstruction as in any medical patient obstruction leads to nausea, vomiting, constipation
What should a pregnant woman not take when constipated and why?
Laxative because it will induce labor
Describe the Urinary System during pregnancy.
- Increased pressure on the bladder from the uterus leads to urinary frequency
- Incidence of glycosuria increases which may be normal or may indicate gestational diabetes
- Focus on no white products and no juices
- UTI’s left untreated will induce premature labor
What is an appropriate suggestion for early morning sickness?
Eat a dry carbohydrate, such as crackers, before arising
What are ways to reduce heartburn in pregnancy?
Eat small frequent meals
Avoid spicy or greasy food
Refrain from laying down immediately after eating
Use low sodium antacids
What is PICA and what does it cause?
Abnormal eating of foods such as clay and it creates anemia resulting in SGA (small for gestational age babies)
What are ways to treat constipation in pregnancy?
Increase fluid and fiber
Exercise in moderation
Use stool softners ex: docusate (Colace)
NO LAXATIVES ex: polyethylene glycol (Murilax)
What can Hemorrhoids be treated?
Ice
Sitz bath
Apply topical anesthetics
What are suggested exercises during pregnancy?
Swimming
Yoga
Avoid heavy lifting
What are interventions for varicose veins?
Elevate legs
Support stockings
Avoid crossing legs and standing for long perioids
What is the recommended weight gain during pregnancy?
25-35 lbs
First three months 3.5-5lbs then 1 pound per week
(need only 300 extra calories)
Inadequate is 2.2lbs per month
Excessive is 6.6lbs per month
What is nutrient is known to prevent spinal cord deviations in the newborn?
Folic acid
What is a bad triple screen level and what can it contribute too?
low level, down syndrome and other chromosome defects
What is the purpose of the diagonal conjugate?
to measure the width of the pelvis, it is measured by the symphisis pubis to the sacral promintary
What can hypertension in pregnancy lead to?
preeclampsia, eclampsia
What can hypertension in pregnancy lead to?
preeclampsia, eclampsia
what is folic acid important for during pregnancy?
nueral tube development
