What are some risk factors for pregnancy?

Blood type & Rh Factor

 Age
 Gravida (# of preg) / para (# of deliveries)
 race/ethnicity, religion, mariatal/family status,
occupaion, education Complete blood count (CBC)
2
Why is it important to take a family history before
pregnancy? Serum cholesterol & glucose
To determine both modifiable & non modifiable risk
factors related to family & genetic history to initiate
Urinalysis
actions to minimize risk
3
What is a healthy BMI Range? HIV
8.5 – 24.9
4 STD: syphilis, gonorrhea, Chlamydia
What BMI classifies being "over weight"?
11
25-29.9 What are Presumptive Signs of pregnancy and what are
5 some examples of them?
What BMI classifies one as "obese"?
Subjective signs can be caused by causes outside of
30+ pregnancy (Physiological changes perceived by the
6 woman)
What BMI Classifies one as underweight?
BMI < 18.5 Amenorrhea
7
What are the different levels of Maslow's hierachy of
needs? Breast changes and tenderness

8 Discoloration of vaginal mucosa

What is preconception counseling and why is it done?
Assessing a woman’s relevant health hx, and physical Increased skin pigmentation and striae
exam for risk factors & implementing interventions
when needed can positively impact her current & future
health – resulting in better health outcomes for women
and families Nausea and Vomiting, Urinary Frequency

9
What are the components of a pre-conception physical Quickening, Fatigue
exam?
12
What are objective signs?
Height & weight to calculate BMI Pregnancy signs that can be perceived by the healthcare
provider
13
Comprehensive physical exam
What are some examples of objective pregnancy signs?
 Chadwick’s
Breast exam  Goodell’s
 Hegar’s
 Ballottement
Pelvic exam  pregnancy
10  Skin changes
What are the Components of a pre-conception lab exam? 14
What is Chadwick's sign, where does it occur, and how
many weeks after conception does it appear?
Pap smear  The vigina, cervix, vulva turns blue/purple in
color
 Occurs after 6-8 weeks from conception
15
What is Goodell's sign, where does it occur, and how
many weeks after conception does it appear?
 It is a Softening & > leukorrhea of the cervix
and vagina
 Occurs after 8 weeks
16
What is Hegar's sign, where does it occur, and how
many weeks after conception does it appear?
 It is a Softening of lower uterus
 Occurs after 6 weeks
17
What are some positive signs of pregnancy?
Fetal Heart Tone
-What: fetal heart beat (doppler)
-Where: near symphysis pubis over shoulder
-When: 10-12 weeks
Fetal movement
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total # of times a woman has been pregnant –
without reference to # fetuses, including a current
pregnancy
25
What does the term "para" mean?
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total # of births after 20 weeks whether alive or still birth
<20 wks = abortion (spontaneous or elective)
> # fetuses’ = one birth
26
What does each leter of the GTPAL system represent?


-What:actual movement Study These Flashcards

-Where: below umbilicus

-When: 20 weeks
Cardiac Visualization G Number of pregnancies (gravidity)
 What: fetal heart by ultrasound
 Where: below symphysis pubis
T Term infants (>37 weeks)
 When: 4-8 weeks
18
How do you determine pregnancy?
P Preterm Infants (<37 weeks)
It is 1st day of the last normal menstrual period (LMP)
to onset of labor
19 A Abortions (spontaneous or therapeutic)
When does the 1st trimester begin?
1st day LMP through 14 completed weeks L Living Children
20
When does the 2nd trimester begin?
15 weeks through 28 completed weeks
Abortions = < 20 weeks
21
How long does the 3rd trimester last? 27
What does Nulli-para or gravid mean?
29 weeks through 40 completed weeks
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22 Never pregnant or given birth
How many days long is a normal pregnancy?
28
280 What does primigravida mean?
23 Study These Flashcards
What is nagele's rule for gestional age? Pregnant for 1st time
29
–First day of LMP What does multigravida mean?

–Subtract 3 months Study These Flashcards

Pregnant for at least a second time
–Add 7 days 30
What does grand multigravida mean?
–Example: LMP Nov 21
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 Subtract 3 months: August 21 Pregnant 5 or more times
 Add 7 days: August 28
31
24
What is the function of the corpus luteum?
What does the term "gravida" mean?
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The main function of HCG is to maintain the corpus
luteum in early pregnancy by producing progesterone. AP diameter increases 2cm
HCG generally is detectable in the maternal serum about
7 days after conception
32 Oxygen consumption increases 15-25%
What is goodell's sign?
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Tidal volume increases 50%
Softening of the cervix. Feels like an earlobe.
33
What is chadwick's sign? Respiratory rate increases slightly
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cyanosis of the cervix due to increase vascularity and
edema Increased vascularity entire upper tract

Mucus plug is the cork at the opening of a bottle an 37

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

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What are some changes in the Musculoskeleteal system
during pregnancy?
Diaphragm elevates 4 cm Study These Flashcards
 Posture changes:
o Lordosis
Transverse diameter increases 2 cm o Center of gravity shift
 Relaxin
  Rectus abdominous Study These Flashcards
 Low back pain
 Side pain
 Leg cramps Sensory changes/compression of nerves
41
What are some integumentary system changes during
pregnancy? Carpal tunnel syndrome due to edema
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 Striae gravidarum - strech marks
 Chloasma Tension headaches
 Darkening of areola, vulva, & linea nigra
 Increased:
o Vascular markings Numbness and tingling related to postural changes
o Oily skin
o Acne 45
 Softening of fingernails
What are some hormonal changes seen in pregnancy?
42 Study These Flashcards
What are some endocrine system changes during  Chorionic villi produce hCG
pregnancy?  hCG maintains corpus luteum
o Indicator for positive test
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 Corpus luteum continues to produce estrogen
and progesterone for 8-10 wks
 Placenta takes over about 10 weeks
Thyroid hypertrophy & increased BMR  Estrogen & progesterone stay up
 FSH and LH stay down
o No follicles mature
Increased need for glucose and insulin 46
Describe fatigue during pregnancy and how would you
treat it?
Decreased tissue sensitivity to insulin
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Placental hormones present

Usually starts very early in pregnancy.

Decreased LH and FSH

May be due to hormonal changes.

Adrenal glands
Most women are “Super Woman”.
–increased aldosterone

–sodium regulation in urine

Remedy:

–Rest and sleep more.

NOTE: human placental lactogen jacks up insulin
sensitivity –Exercise regularly (walking, swimming, etc.)

43 –Usually corrects itself during 2nd trimester.

What are some hematologic changes during pregnancy?
Study These Flashcards –Check blood count, eat healthy foods.
 Decreases: 47
o Hemoglobin (<10 – anemia) What are some weight gain changes seen with
o Hematocrit (31.9 to 36.5% are ok) pregnancy?
o Fibrinolysis (prone to clots)
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 Increases:
o Fibrinogen (30-50%) –BMI = 18.5 – 24.9 Total gain of 25-35lb .
o Coagulation Factors (VII-X)
o WBC –1st trimester gain of 3-4.4 lbs
44
What are some neurological system changes during –2nd and 3rd trimester 1lb./wk
pregnancy?
48 •Assessment of fetal well-being
What is the "fundal height?"
Study These Flashcards •Pelvic examination
The height of the belly measured from the top of the
symphysis pubis to the top of the uterine fundus. •Leopold’s maneuver
Findings may differ if the women is obese, has uterine
fibroids, or has poly/oligohydramnios •Nutritional follow-up
49
•Screening for group B streptococcus --> can lead to
What is leopold's maneuvers?
respiratory stress syndrome
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•Laboratory tests
Abdominal palpation that shows the degree of:
•Patient education and anticipatory guidance
 uterine irritability
 tone
 tenderness •
 current contractility 53
 and fetal movement What are the maternal tasks of pregnancy?
50
What are some changes seen in the women during the Study These Flashcards
2nd trimester?
•Ensuring safe passage for herself and her child
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•Ensuring social acceptance of the child by significant
•BP may slightly decrease during 2nd trimester others

•Urine dip stick for glucose, albumin & ketones •Attaching or “binding-in” to the child refers to the
development of maternal-fetal attachment
•FHR (110 – 160 bpm)
•Giving of oneself to the demands of being a mother
•Fetal movement = quickening
54
What are the 7 dimenstions of maternal role
•Fundal height = cm = wk gestation
development?
•Edema lower extremities Study These Flashcards
1. Acceptance of pregnancy
•Ultra sound = 18 – 20 wks to confirm EDD & anatomy 2. Identification with the motherhood role
3. Relationship to her mother
51 4. Reordering relationship with her husband or
What are some laboratory & diagnositc tests done during partner
the 2nd trimester? 5. Preparation for labor
Study These Flashcards 6. Prenatal fear of control in labor
7. Prenatal fear of loss of self-esteem in labor
•Triple or quad screen (15 – 20 wks) *> = chromosome 55
& < = NTD What is Couvade Syndrome?
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•1 hr GTT (24 – 28 wks) if > = 3 hr GTT
a condition in which men may experience pregnancy
•Hgb & HCT (24 – 28 wks) because blood volume symptoms and discomforts similar to their pregnant
increases partner.

•Syphilis serology PRN, syphilis can’t pass to baby prior 56

to 18 weeks What are some father's worries with pregnancy?
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•Antibody screen for Rh – negative women
•Financial

52 •Changing relationship/wife and friends

What kind of assessment will be conducted during the
3rd trimester? •Sexual responsiveness of wife
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•Safety of wife and infant
•Focused assessment
•Role in L&D

•Ability to father

•Disturbed feelings toward the baby

57
What are the 3 phases of developmental tasks of fathers?
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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