Urinalysis

What are some risk factors for pregnancy?

HIV
● Age
● Gravida (# of preg) / para (# of deliveries) STD: syphilis, gonorrhea, Chlamydia
● race/ethnicity, religion, mariatal/family status,
occupaion, education 11
What are Presumptive Signs of pregnancy and what are
some examples of them?
2
Why is it important to take a family history before
pregnancy? Subjective signs can be caused by causes outside of
To determine both modifiable & non modifiable risk pregnancy (Physiological changes perceived by the
factors related to family & genetic history to initiate woman)
actions to minimize risk
Amenorrhea
3
What is a healthy BMI Range?
Breast changes and tenderness
18.5 – 24.9
Discoloration of vaginal mucosa
4
What BMI classifies being "over weight"?
Increased skin pigmentation and striae
25-29.9
5 Nausea and Vomiting, Urinary Frequency
What BMI classifies one as "obese"?
Quickening,  Fatigue
30+
12
6 What are objective signs?
What BMI Classifies one as underweight?
Pregnancy signs that can be perceived by the healthcare
BMI < 18.5 provider
7 13
What are the different levels of Maslow's hierachy of What are some examples of objective pregnancy signs?
needs?
● Chadwick’s
8
What is preconception counseling and why is it done? ● Goodell’s

Assessing a woman’s relevant health hx, and physical ● Hegar’s

exam for risk factors & implementing interventions
when needed can positively impact her current & future ● Ballottement
health – resulting in better health outcomes for women
and families ● pregnancy
9
What are the components of a pre-conception physical ● Skin changes
exam?
14
Height & weight to calculate BMI What is Chadwick's sign, where does it occur, and how
many weeks after conception does it appear?
Comprehensive physical exam
● The vigina, cervix, vulva turns blue/purple in
color
Breast exam
● Occurs after 6-8 weeks from conception
Pelvic exam
15
10 What is Goodell's sign, where does it occur, and how
What are the Components of a pre-conception lab exam? many weeks after conception does it appear?

Pap smear ● It is a Softening & > leukorrhea of the cervix

and vagina
Blood type & Rh Factor ● Occurs after 8 weeks

16
 Complete blood count (CBC)
What is Hegar's sign, where does it occur, and how
many weeks after conception does it appear?
Serum cholesterol & glucose
 ● It is a Softening of lower uterus without reference to # fetuses, including a current
● Occurs after 6 weeks pregnancy
25
17
What does the term "para" mean?
What are some positive signs of pregnancy?
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     Fetal Heart Tone
total # of births after 20 weeks whether alive or still birth
● -What: fetal heart beat (doppler) <20 wks = abortion (spontaneous or elective)
● -Where: near symphysis pubis over shoulder > # fetuses’ = one birth
● -When: 10-12 weeks 26
What does each leter of the GTPAL system represent?
     Fetal movement
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● -What:actual movement
● -Where: below umbilicus G  Number of pregnancies (gravidity)
● -When: 20 weeks
T   Term infants (>37 weeks)
      Cardiac Visualization
P   Preterm Infants (<37 weeks)
● What: fetal heart by ultrasound
● Where: below symphysis pubis A   Abortions (spontaneous or therapeutic)
● When: 4-8 weeks
L   Living Children
18
How do you determine pregnancy?  
It is 1st day of the last normal menstrual period (LMP)
to onset of labor Abortions = < 20 weeks
19 27
When does the 1st trimester begin? What does Nulli-para or gravid mean?
1st day LMP through 14 completed weeks Study These Flashcards
Never pregnant or given birth
20
When does the 2nd trimester begin? 28
What does primigravida mean?
15 weeks through 28 completed weeks
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21 Pregnant for 1st time
How long does the 3rd trimester last?
29
29 weeks through 40 completed weeks What does multigravida mean?
22 Study These Flashcards
How many days long is a normal pregnancy? Pregnant for at least a second time
280 30
23 What does grand multigravida mean?
What is nagele's rule for gestional age? Study These Flashcards
Pregnant 5 or more times
–First day of LMP
31
–Subtract 3 months What is the function of the corpus luteum?
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–Add 7 days The main function of HCG is to maintain the corpus
luteum in early pregnancy by producing progesterone.
–Example: LMP Nov 21 HCG generally is detectable in the maternal serum about
7 days after conception
● Subtract 3 months: August 21 32
● Add 7 days: August 28 What is goodell's sign?

24 Study These Flashcards

What does the term "gravida" mean? Softening of the cervix. Feels like an earlobe.

Study These Flashcards 33

What is Chadwick'schadwick's sign?
total # of times a woman has been pregnant – Study These Flashcards
cyanosis of the cervix due to increase vascularity  and 37
edema What are some changes in the renal system during
pregnancy?
Mucus plug is the cork at the opening of a bottle an
obstructs the cervical canal due to proliferation of the Study These Flashcards
mucus glands. Mucus forms within the cervix and serves
to protect the fetus from ascending infectious bacteria ● Renal plasma blood flow increases 50%
● GFR increases
34
● Increased excretion:
What are some changes in the cardiovascular system
o Bicarbonate
during pregnancy?
o Creatinine
Study These Flashcards ● Dilation of renal pelves and ureters
● Relaxation of bladder smooth muscle (stasis)
● Blood Volume increases by 1600 ml ● If glucose >160 – may spill in urine.
● Heart Rate increases 15-20 bpm ● Protein in urine may indicate preeclampsia.
● Body water increases 6-8 liters
● Heart sounds: systolic ejection murmur 38
● Vascular changes: What are some changes in the gastrointestinal system
with pregnancy?
–SVR decreases 20%
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–PVR down 34%
● Salivary glands more active
● Increased vascularity in gums and mucus
● Arterial blood pressure: membranes
● Teeth – loss of minerals
–decreased 2nd trimester ● Decreased motility and tone in stomach and
intestines
–back to normal by term o Contributes to reflux and heartburn
o Constipation & hemorrhoids
35 ● Function of gallbladder and liver slower
What is supine hypotension syndrome? o Increased risk of gallstones
Study These Flashcards ● Functional Changes:
Occurs when woman is lying on her back. Enlarged, o N/V (esp 1st trimester)
heavy uterus presses on the inferior vena cava causing o Hyperemesis gravidarum
reduced blood flow back to the right atrium. This results ▪ May require hospitalization
in: o Altered tastes & cravings
o Increased appetite (esp 2nd trimester)
–Hypotension
–Fainting 39
–Dizziness What is Hyperemesis Gravidarum?
 
Keep woman on her side or upright Study These Flashcards
BP changes of concern: excessive vomiting and weight loss with dehydration.
–Systolic 30 mmHG Not a frequent occurrence, and occurs after 15 weeks
–Diastolic 15 mmHG from conception.  She will also complain of severe
–>140/90 dehydration
36 40
What are some respiratory system changes seen in the What are some changes in the Musculoskeleteal system
respiratory system with pregnancy? during pregnancy?
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Diaphragm elevates 4 cm ● Posture changes:

o Lordosis
Transverse diameter increases 2 cm o Center of gravity shift
● Relaxin
AP diameter increases 2cm ● Rectus abdominous
● Low back pain
Oxygen consumption increases 15-25% ● Side pain
● Leg cramps
Tidal volume increases 50%
41
What are some integumentary system changes during
Respiratory rate increases slightly
pregnancy?
Increased vascularity entire upper tract Study These Flashcards
 ● Striae gravidarum - strech marks What are some hormonal changes seen in pregnancy?
● Chloasma
● Darkening of areola, vulva, & linea nigra Study These Flashcards
● Increased:
o Vascular markings ● Chorionic villi produce hCG
o Oily skin ● hCG maintains corpus luteum
o Indicator for positive test
o Acne
● Softening of fingernails ● Corpus luteum continues to produce estrogen
and progesterone for 8-10 wks
● Placenta takes over about 10 weeks
42
● Estrogen & progesterone stay up
What are some endocrine system changes during
● FSH and LH stay down
pregnancy?
o No follicles mature
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46
Thyroid hypertrophy & increased BMR Describe fatigue during pregnancy and how would you
treat it?
Increased need for glucose and insulin Study These Flashcards

Decreased tissue sensitivity to insulin Usually starts very early in pregnancy.

Placental hormones present May be due to hormonal changes.

Decreased LH and FSH Most women are “Super Woman”.

Adrenal glands  

–increased aldosterone Remedy:

–sodium regulation in urine –Rest and sleep more.

  –Exercise regularly (walking, swimming, etc.)

NOTE: human placental lactogen jacks up insulin –Usually corrects itself during 2nd trimester.
sensitivity
43 –Check blood count, eat healthy foods.
What are some hematologic changes during pregnancy?
47
Study These Flashcards What are some weight gain changes seen with
pregnancy?
● Decreases: Study These Flashcards
o Hemoglobin (<10 – anemia)
o Hematocrit (31.9 to 36.5% are ok)
–BMI = 18.5 – 24.9 Total gain of 25-35lb .
o Fibrinolysis (prone to clots)
 
● Increases: –1st trimester gain of 3-4.4 lbs
o Fibrinogen (30-50%)
o Coagulation Factors (VII-X) –2nd and 3rd trimester 1lb./wk
o WBC 48
What is the "fundal height?"
44
What are some neurological system changes during Study These Flashcards
pregnancy? The height of the belly measured from the top of the
symphysis pubis to the top of the uterine fundus. 
Study These Flashcards Findings may differ if the women is obese, has uterine
fibroids, or has poly/oligohydramnios
Sensory changes/compression of nerves
49
What is leopold's maneuvers?
Carpal tunnel syndrome due to edema
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Tension headaches
Abdominal palpation that shows the degree of:
Numbness and tingling related to postural changes
● uterine irritability
45 ● tone
 ● tenderness •Patient education and anticipatory guidance          
● current contractility
● and fetal movement •

50
What are some changes seen in the women during the
2nd trimester?
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•BP may slightly decrease during 2nd trimester
•Urine dip stick for glucose, albumin & ketones
53
What are the maternal tasks of pregnancy?
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•Ensuring safe passage for herself and her child
•Ensuring social acceptance of the child by significant
others

•FHR (110 – 160 bpm) •Attaching or “binding-in” to the child refers to the
development of maternal-fetal attachment
•Fetal movement = quickening
•Giving of oneself to the demands of being a mother
•Fundal height = cm = wk gestation 54
What are the 7 dimenstions of maternal role
•Edema lower extremities development?
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•Ultra sound = 18 – 20 wks to confirm EDD & anatomy
51 1. Acceptance of pregnancy
What are some laboratory & diagnositc tests done during 2. Identification with the motherhood role
the 2nd trimester? 3. Relationship to her mother
4. Reordering relationship with her husband or
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5. Preparation for labor
•Triple or quad screen (15 – 20 wks) *> = chromosome  6. Prenatal fear of control in labor
& < = NTD 7. Prenatal fear of loss of self-esteem in labor

•1 hr GTT (24 – 28 wks) if > = 3 hr GTT 55

What is Couvade Syndrome?
•Hgb & HCT (24 – 28 wks)  because blood volume Study These Flashcards
increases
a condition in which men may experience pregnancy
•Syphilis serology PRN, syphilis can’t pass to baby prior symptoms and discomforts similar to their pregnant
to 18 weeks partner.

•Antibody screen for Rh – negative women 56

What are some father's worries with pregnancy?
 
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52
What kind of assessment will be conducted during the •Financial
3rd trimester?
Study These Flashcards •Changing relationship/wife and friends

•Focused assessment •Sexual responsiveness of wife

•Assessment of fetal well-being •Safety of wife and infant

•Pelvic examination •Role in L&D

•Leopold’s maneuver •Ability to father

•Nutritional follow-up •Disturbed feelings toward the baby

57
•Screening for group B streptococcus --> can lead to What are the 3 phases of developmental tasks of fathers?
respiratory stress syndrome
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•Laboratory tests    
1. Announcement phase
  –May react with joy, distress or combined emotions

2. Moratorium phase Thought of PG put aside:

  –Fear of hurting baby with sex, Feelings of rivalry

  –Task = accepting the PG (wife and fetus)

3.Focusing phase – active involvement with fetus

  –Task – role in L&D and parenting