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77777777777777777777777777777777777777777 What is preconception counseling and why is it done?

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77777777777777777777777777777777777777777 Assessing a woman’s relevant health hx, and physical
77777777777777777777777777777777777777777 exam for risk factors & implementing interventions
77777777777777777777777777777777777777777 when needed can positively impact her current & future
77777777777777777777777777777777777777777 health – resulting in better health outcomes for women
77777777777777777777777777777777777777777 and families
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77777777777777777777777777777777777777777 What are the components of a pre-conception physical
77777777777777777777777777777777777777777 exam?
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77777777777777777777777777777777777777777 Height & weight to calculate BMI
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77777777777777777777777777777777777777777 Comprehensive physical exam
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77777777777777777777777777777777777777777 Breast exam
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77777777777777777777777777777777777777777 Pelvic exam
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What are the Components of a pre-conception lab exam?
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77777777777777777777777777777777777777777 Pap smear
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77777777777777777777777777777777777777777 Blood type & Rh Factor
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77777777777777777What are some risk factors for  Complete blood count (CBC)
pregnancy?
Serum cholesterol & glucose
● Age
Urinalysis
● Gravida (# of preg) / para (# of deliveries)
● race/ethnicity, religion, mariatal/family status, HIV
occupaion, education
STD: syphilis, gonorrhea, Chlamydia
2 11
Why is it important to take a family history before What are Presumptive Signs of pregnancy and what are
pregnancy? some examples of them?
To determine both modifiable & non modifiable risk
factors related to family & genetic history to initiate
Subjective signs can be caused by causes outside of
actions to minimize risk
pregnancy (Physiological changes perceived by the
3 woman)
What is a healthy BMI Range?
Amenorrhea
18.5 – 24.9
4 Breast changes and tenderness
What BMI classifies being "over weight"?
25-29.9 Discoloration of vaginal mucosa

5 Increased skin pigmentation and striae

What BMI classifies one as "obese"?
30+ Nausea and Vomiting, Urinary Frequency
6
Quickening,  Fatigue
What BMI Classifies one as underweight?
12
BMI < 18.5
What are objective signs?
7
Pregnancy signs that can be perceived by the healthcare
What are the different levels of Maslow's hierachy of
provider
needs?
13       Cardiac Visualization
What are some examples of objective pregnancy signs?
● What: fetal heart by ultrasound
● Chadwick’s
● Where: below symphysis pubis
● When: 4-8 weeks
● Goodell’s

18
● Hegar’s How do you determine pregnancy?
It is 1st day of the last normal menstrual period (LMP)
● Ballottement to onset of labor
19
● pregnancy When does the 1st trimester begin?
1st day LMP through 14 completed weeks
● Skin changes 20
When does the 2nd trimester begin?
14
What is Chadwick's sign, where does it occur, and how 15 weeks through 28 completed weeks
many weeks after conception does it appear? 21
How long does the 3rd trimester last?
● The vigina, cervix, vulva turns blue/purple in 29 weeks through 40 completed weeks
color
22
● Occurs after 6-8 weeks from conception How many days long is a normal pregnancy?
280
15
What is Goodell's sign, where does it occur, and how 23
many weeks after conception does it appear? What is nagele's rule for gestional age?

● It is a Softening & > leukorrhea of the cervix –First day of LMP

and vagina
–Subtract 3 months
● Occurs after 8 weeks
–Add 7 days
16
What is Hegar's sign, where does it occur, and how –Example: LMP Nov 21
many weeks after conception does it appear?

● Subtract 3 months: August 21

● It is a Softening of lower uterus
● Add 7 days: August 28
● Occurs after 6 weeks
24
17 What does the term "gravida" mean?
What are some positive signs of pregnancy?
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     Fetal Heart Tone
total # of times a woman has been pregnant –
● -What: fetal heart beat (doppler)
● -Where: near symphysis pubis over shoulder without reference to # fetuses, including a current
pregnancy
● -When: 10-12 weeks
25
What does the term "para" mean?
     Fetal movement
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total # of births after 20 weeks whether alive or still birth
● -What:actual movement
<20 wks = abortion (spontaneous or elective)
● -Where: below umbilicus > # fetuses’ = one birth
● -When: 20 weeks 26
What does each letter of the GTPAL system represent?
Study These Flashcards Study These Flashcards

G  Number of pregnancies (gravidity) ● Blood Volume increases by 1600 ml

T   Term infants (>37 weeks) ● Heart Rate increases 15-20 bpm
● Body water increases 6-8 liters
P   Preterm Infants (<37 weeks)
● Heart sounds: systolic ejection murmur
A   Abortions (spontaneous or therapeutic) ● Vascular changes:

L   Living Children –SVR decreases 20%

  –PVR down 34%

Abortions = < 20 weeks

● Arterial blood pressure:
27
What does Nulli-para or gravid mean? –decreased 2nd trimester
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Never pregnant or given birth –back to normal by term
28 35
What does primigravida mean? What is supine hypotension syndrome?
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Pregnant for 1st time Occurs when woman is lying on her back. Enlarged,
29 heavy uterus presses on the inferior vena cava causing
What does multigravida mean? reduced blood flow back to the right atrium. This results
in:
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Pregnant for at least a second time –Hypotension
–Fainting
30 –Dizziness
What does grand multigravida mean?  
Study These Flashcards Keep woman on her side or upright
Pregnant 5 or more times BP changes of concern:
–Systolic 30 mmHG
31 –Diastolic 15 mmHG
What is the function of the corpus luteum? –>140/90
Study These Flashcards 36
The main function of HCG is to maintain the corpus What are some respiratory system changes seen in the
luteum in early pregnancy by producing progesterone. respiratory system with pregnancy?
HCG generally is detectable in the maternal serum about Study These Flashcards
7 days after conception
32 Diaphragm elevates 4 cm
What is goodell's sign?
Transverse diameter increases 2 cm
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Softening of the cervix. Feels like an earlobe.
AP diameter increases 2cm
33
What is Chadwick'schadwick's sign? Oxygen consumption increases 15-25%
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cyanosis of the cervix due to increase vascularity  and Tidal volume increases 50%
edema
Respiratory rate increases slightly
Mucus plug is the cork at the opening of a bottle an
obstructs the cervical canal due to proliferation of the
mucus glands. Mucus forms within the cervix and serves Increased vascularity entire upper tract
to protect the fetus from ascending infectious bacteria 37
34 What are some changes in the renal system during
What are some changes in the cardiovascular system pregnancy?
during pregnancy? Study These Flashcards
 ● Renal plasma blood flow increases 50% ● Leg cramps
● GFR increases
41
● Increased excretion: What are some integumentary system changes during
o Bicarbonate pregnancy?
o Creatinine
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● Dilation of renal pelves and ureters
● Relaxation of bladder smooth muscle (stasis) ● Striae gravidarum - strech marks

● If glucose >160 – may spill in urine. ● Chloasma

● Protein in urine may indicate preeclampsia. ● Darkening of areola, vulva, & linea nigra
● Increased:
38 o Vascular markings
What are some changes in the gastrointestinal system o Oily skin
with pregnancy?
o Acne
Study These Flashcards ● Softening of fingernails

● Salivary glands more active 42

What are some endocrine system changes during
● Increased vascularity in gums and mucus
pregnancy?
membranes
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● Teeth – loss of minerals
● Decreased motility and tone in stomach and Thyroid hypertrophy & increased BMR
intestines
o Contributes to reflux and heartburn Increased need for glucose and insulin
o Constipation & hemorrhoids
● Function of gallbladder and liver slower Decreased tissue sensitivity to insulin
o Increased risk of gallstones
Placental hormones present
● Functional Changes:
o N/V (esp 1st trimester) Decreased LH and FSH
o Hyperemesis gravidarum
▪ May require hospitalization Adrenal glands
o Altered tastes & cravings
o Increased appetite (esp 2nd trimester) –increased aldosterone

39 –sodium regulation in urine

What is Hyperemesis Gravidarum?
 
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excessive vomiting and weight loss with dehydration.
Not a frequent occurrence, and occurs after 15 weeks NOTE: human placental lactogen jacks up insulin
from conception.  She will also complain of severe sensitivity
dehydration 43
40 What are some hematologic changes during pregnancy?
What are some changes in the Musculoskeleteal system Study These Flashcards
during pregnancy?
Study These Flashcards ● Decreases:
o Hemoglobin (<10 – anemia)
● Posture changes: o Hematocrit (31.9 to 36.5% are ok)
o Lordosis o Fibrinolysis (prone to clots)
o Center of gravity shift  
● Relaxin ● Increases:
o Fibrinogen (30-50%)
● Rectus abdominous o Coagulation Factors (VII-X)
● Low back pain o WBC

● Side pain 44
What are some neurological system changes during –2nd and 3rd trimester 1lb./wk
pregnancy?
48
Study These Flashcards What is the "fundal height?"
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Sensory changes/compression of nerves The height of the belly measured from the top of the
symphysis pubis to the top of the uterine fundus. 
Carpal tunnel syndrome due to edema Findings may differ if the women is obese, has uterine
fibroids, or has poly/oligohydramnios
Tension headaches
49
What is leopold's maneuvers?
Numbness and tingling related to postural changes
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45
What are some hormonal changes seen in pregnancy?
Abdominal palpation that shows the degree of:
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● uterine irritability
● Chorionic villi produce hCG
● tone
● hCG maintains corpus luteum
● tenderness
o Indicator for positive test
● Corpus luteum continues to produce estrogen ● current contractility
and progesterone for 8-10 wks ● and fetal movement
● Placenta takes over about 10 weeks
50
● Estrogen & progesterone stay up What are some changes seen in the women during the
● FSH and LH stay down 2nd trimester?
o No follicles mature Study These Flashcards

46 •BP may slightly decrease during 2nd trimester

Describe fatigue during pregnancy and how would you
treat it?
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Usually starts very early in pregnancy.
May be due to hormonal changes.
Most women are “Super Woman”.
Remedy:
–Rest and sleep more.
–Exercise regularly (walking, swimming, etc.)
–Usually corrects itself during 2nd trimester.
–Check blood count, eat healthy foods.
47
What are some weight gain changes seen with
pregnancy?
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–BMI = 18.5 – 24.9 Total gain of 25-35lb .
–1st trimester gain of 3-4.4 lbs
•Urine dip stick for glucose, albumin & ketones
•FHR (110 – 160 bpm)
•Fetal movement = quickening
•Fundal height = cm = wk gestation
•Edema lower extremities
•Ultra sound = 18 – 20 wks to confirm EDD & anatomy
51
What are some laboratory & diagnositc tests done during
the 2nd trimester?
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•Triple or quad screen (15 – 20 wks) *> = chromosome 
& < = NTD
•1 hr GTT (24 – 28 wks) if > = 3 hr GTT
•Hgb & HCT (24 – 28 wks)  because blood volume
increases
•Syphilis serology PRN, syphilis can’t pass to baby prior
to 18 weeks
•Antibody screen for Rh – negative women
  56
What are some father's worries with pregnancy?
52
What kind of assessment will be conducted during the Study These Flashcards
3rd trimester?
Study These Flashcards •Financial

•Focused assessment •Changing relationship/wife and friends

•Assessment of fetal well-being •Sexual responsiveness of wife

•Pelvic examination •Safety of wife and infant

•Leopold’s maneuver •Role in L&D

•Nutritional follow-up •Ability to father

•Screening for group B streptococcus --> can lead to •Disturbed feelings toward the baby
respiratory stress syndrome 57
What are the 3 phases of developmental tasks of fathers?
•Laboratory tests    
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•Patient education and anticipatory guidance          
1. Announcement phase
•
  –May react with joy, distress or combined emotions
53
What are the maternal tasks of pregnancy? 2. Moratorium phase Thought of PG put aside:
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  –Fear of hurting baby with sex, Feelings of rivalry
•Ensuring safe passage for herself and her child
  –Task = accepting the PG (wife and fetus)
•Ensuring social acceptance of the child by significant
others 3.Focusing phase – active involvement with fetus

•Attaching or “binding-in” to the child refers to the   –Task – role in L&D and parenting
development of maternal-fetal attachment  

•Giving of oneself to the demands of being a mother

54
What are the 7 dimenstions of maternal role
development?
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1. Acceptance of pregnancy
2. Identification with the motherhood role
3. Relationship to her mother
4. Reordering relationship with her husband or
partner
5. Preparation for labor
6. Prenatal fear of control in labor
7. Prenatal fear of loss of self-esteem in labor

55
What is Couvade Syndrome?
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a condition in which men may experience pregnancy

symptoms and discomforts similar to their pregnant
partner.