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Antepartum
BC3 Maternity
| Question | Answer |
|---|---|
| Physiological Anemia | normal due to increase blood volume |
| Blood Volume during pregnancy | up 30-50% |
| Pseudoanemia | HGB 11, HCT 37% |
| True Anemia during pregnancy | HGB under 10, HCT under 35% |
| Leukocytes during pregnancy | above 10,000 - reflects increased blood volume and increased protection against infection for mother |
| Pregnancy is a hypercoagulable state therefore what happens .... | increased risk of thrombophlebitis or venous thrombosis (Increased circulating fibrinogen & fibrin |
| GI system changes during pregnancy | intestines and stomach are displaced by increasing uterus - appendix can be as high as the right flank |
| What is the cause of n/v during pregnancy | primarily result of high HCG levels and progesterone/estrogen levels; can occur 1-2 weeks after conception |
| Treatment for n/v | dry crackers prior to sitting up (CHO foods) - eat small meals throughout the day - limit fluids with meals - avoid fatty foods - take prenatal vits at night |
| Relaxin | hormone secreted by corpus luteum and stimulated by progesterone - softens the cervix and relaxes the uterus; also relaxes the cardiac sphincter and stomach leading to reflux and heartburn |
| Constipation is caused by | decreased motility of the intestines and prolonged emptying and absorption time r/t the relaxin - may also be the result of increased pressure from the uterus |
| Tx of constipation during pregnancy | fiber, increase fluids and activity (eat lots of fruits and veggies - walk regularly) |
| Gall bladder function and tone during pregnancy | decreased; gall bladder may also become distended which can lead to gallstones and disease - decreased emptying of bile from the gallbladder leads to reabsorption of bilirubin which causes dry itching skin |
| Gums & teeth during pregnancy | can be swollen - increase blood supply to teeth, increased acid content of mouth and increased eating can lead to tooth decay |
| Urinary system during pregnancy | progesterone & relaxin cause relaxation of smooth muscle through the urinary system especially in 1st & 3rd trimester |
| Urinary stasis during pregnancy | common - important to drink lots of water |
| What causes pressure on the bladder | the enlarging uterus - especially during 3rd trimester can cause frequency |
| Lab changes during pregnancy | decrease is specific gravity, BUN and creatinine, tendency to spill dextrose in urine (1+) |
| Pica | craving for non-food items such as starch, dirt, chalk, ice |
| Skeletal system changes during pregnancy | relaxin causes gradual softening of pelvic ligaments leading to excess mobility of the joints |
| Pelvic instability | puts more strain on the back muscles and thighs |
| Endocrine changes during pregnancy | Thyroid & pituitary slighly enlarges; Adrenals also slightly enlarge and their activity increases |
| What is the major endocrine gland during pregnancy | the placenta |
| Anterior lobe responsible for | gonadotropins suppressed to stop ovulation & menstruation; Prolactin secreted - responsible for initial lactation |
| Posterior lobe responsible for | secretes Oxytocin which promotes uterine contracitility during pregnancy and stimulates the ejection of breast milk |
| HCG | All blood and urine pregnancy tests are based on the presence of this hormone |
| What excretes HCG | chorionic villi of implanted ovum |
| What does HCG do | prolongs the life of the corpus luteum, which leads to continued production of estrogen and progesterone until the placenta takes over after the second month of pregnancy |
| Chronic villi | produce Human Placental Lactogen (HPL) - this influences cell growth of the fetus and stimulates breast changes for lactation and is present in maternal serum by the 6th week |
| Aldosterone | increases and is responsible for the retention of sodium by the kidneys. Any imbalance here can lead to Na retention and edema |
| Neurologic changes during pregnancy | sensory changes in legs, back pain r/t lumbar lordosis, carpal tunnel syndrome, acrothesia, tension HA, light headedness, stuffy nose |
| Lumbar lordosis | the overexaggerated curve of the lumbar spine |
| Acrothesia | ?? |
| Danger signs of pregnancy | PROM, vaginal bleeding, severe HA/blurred vision, abdominal pain, temp 101.9/chills, swelling of lower legs, hands and face, absence of fetal movement |
| PROM | Premature Rupture of Membranes - sudden gush of clear fluid from vagina |
| What are the risks r/t PROM | infection and premature labor |
| Assessment of vaginal bleeding | depends on timing |
| Light spotting | early is normal |
| Bright red bleeding early | could indicate a spontaneous abortion |
| Brigh red bleeding later | could indicate a placental problem |
| Assessment of abdominal pain | depends on time - sharp cramping indicates danger sign |
| Oral temp above 101.9 F | could indicate infection |
| Swelling of lower legs, hands and face | not uncommon, but if peri-orbital or increased weight gain it could indicate pre-eclampsia |
| When is the first fetal movement felt | usually 18-20 weeks for first time moms; second time moms may feel earlier b/c they know what they are feeling |
| What is one component of amniotic fluid | fetal urine |
| Hyperemesis gravidum | persistent vomitting - every day for 1st trimester |
| Tx of Hyperemesis gravidum | hospitalized with central line for weeks - TPN; mom is worse off than baby |
| When can an US detect gestational sac | 5-6 weeks |
| When can an US show fetal heart beating | 11 weeks |
| When can an US detect fetal breathing | 11 weeks |
| When can an US show fetal movement | 12 weeks |
| When should mom report n/v | if she shows signs of dehydration and concentrated urine |
| What should mom do in regards to urinary frequency | good cleanliness - reports signs of UTI - drink 2000 mL/day (bladder spasms can lead to uterine contractions) |
| What should a mom do about heartburn | Avoid baking soda - may take Maalox (give her a measurable amount) |
| How can a mom decrease edema and varicosities | keep legs elevated as much as possible |
| What can a mom do about a backache | good posture is important |
| What should a mom do about faintness | moderate exercise, deep breathing, avoid sudden changes in position and warm crowded areas (usually happens in 1st trimester) |
| What can a mom do regarding Vena Caval Syndrome | teach to lie on side - not back |
| Breast Care during pregnancy | wide straps, bras large enough, good cleanliness, check if nipples are inverted - use nipple shield |
| Nipple stimulation | may stimulate uterine activity - should be avoided during last trimester if there is any danger of pre-term labor |
| Exercise | moderate exercise is important to strengthen muscles for childbirth (no full sit-ups); Kegel exercises and Pelvic tilt |
| Sexual activity | only limited if woman prone to pre-term labor, bleeding or ROM |
| Teratogens | subsatnce that harm the growth and development of fetus -can be alcohol, cocaine, caffein, etc., |
| Overall weight gain during pregnancy | 25-35 pounds |
| Caloric intake | should only increase by 300 Kcal/day above usual allowance (Approx 18Kcal/lb of mom's ideal body weight) |
| Weight gain during the first trimester | 2-4 pounds |
| Weight gein during the 2nd and 3rd trimester | 0.8-1 pound / week |
| A sharp weight gain after the 20th week may indicate | increased water retention and the beginning of PIH |
| What do CHO provide | Protective substances (vitamins & minerals), bulk (fiber), and energy |
| CHO promote | weight gain and growth of the fetus, placenta and other maternal tissues |
| Sources of CHO | milk, fruit, veggies & whole-grain cereals & bread |
| Fats provide | essential fatty acidsq |
| Function of protein | build and repair all body cells - preferably not to be used as an energy source |
| Increased amount of protein is needed during pregnancy for | growth & development of maternal and fetal tissue |
| Vitamins | organic substances essential to life |
| Fat-soluable vitamins | ADEK - stored by body, it is possible to overdose with large supplements |
| Water soluable vitamins | all B's & C's - not stored in the body, need replenishing - excreted in urine |
| Dairy needs for pregnant woman | 2 servings |
| Grain needs for pregnant woman | 6-11 servings |
| Fat needs for pregnant woman | 2 servings |
| Veggie needs for pregnant woman | 3-5 servings |
| Fruit needs for pregnant woman | 2-4 servings |
| Meat needs for pregnant woman | 2-3 servings |
| Antiflexed | uterus bends forward |
| Dextrorotate | uterus turns to the right |
| Size changes of the uterus | Normal 60-70g goes to 1100-1200g; Capacity 10ml (2tsp) - greater than gallon |
| The growth of the uterus is principally r/t | enlargement of pre-existing muscle fibers |
| The effect of estrogen on uterine muscle | increase fibroelastic tissue between the muscle bands |
| Braxton - Hicks | painless, irregular, beginning of 4th month, prepare the uterus for labor |
| Fundal height is important to assess to determine | fetal well-being |
| Fundal height is first palpable | above symphysis at 12 weeks at umbilicus by 20 wks |
| How is fundal height measured & when | with a paper tape from the symphysis to fundus of uterus at prenatal visits |
| Fundal Height # of weeks gestation = | # of centimeters measured until 3rd trimester (17wks gest = 17cm) |
| McDonald's Rule (wks) | # of cm x 8/7 = wks gestation |
| McDonald's Rule (months) | # of cm x 2/7 = duration of pregnancy in months |
| If the fundal height is low for gestation | IUGR due to problems with placenta or other disorders |
| If fundal height is greater than it should be for gestational age | twins, hydraminios, hydatidiform mole, internal hemorrhage |
| Goodell's Sign | Cervix softens with pregnancy |
| Normal cervix feels like | the tip of the nose |
| The pregnant cervis feels like | an earlobe |
| The cervix is bluish discoloration is due to | increased vascularity |
| operculum | mucous plug |
| Why is the mucous plug formed | due to increased excretion of endocervical glands |
| Chadwick's sign | vagina has increased vascularity which leads to blue discoloration |
| If mom gets yeast infections, newborn can get? | thrush |
| Vaginal pH | acidic during pregnancy to discourage bacteria - but can encourage yeast infections |
| Breast changes in pregnancy r/t | increased circulation and increased endocrine activity |
| What are the breast changes | larger, firmer, tender; areola enlarges & darkens; colostrum can be expressed during last trimester |
| Abdominal wall changes | stretches to accommodate uterus; stretch marks on abd., thighs, breasts; Diastasis recti |
| Striae Gravidarum | Stretch marks (younger women tend to have less) |
| Diastasis Recti | separation of the rectus muscle of the abdomen; May leave a blue groove on the abdomen |
| Skin Changes | Linea Nigra; Cloasma; Spidernevi; Glowing |
| Linea Nigra | Black line from mons veneris to umbilicus; r/t increased hormones; will lighten 6-12 wks post partum |
| Cloasma | Mask of pregnancy; r/t hormones; sunburn like |
| Spidernevi | Vascular, spider-like red blemishes on the skin with branching legs; do disappear |
| Glowing | increased activity of sebaceous & sweat glands |
| Metabolic changes (BMR) | BMR increased 15-20% |
| Metabolic changes (CHO) | pregnancy mimics a subclinical diabetes; glucose excreted in urine - don't test urine for glucose it won't be accurate |
| Metabolic changes (weight gain) | r/t presence of grownig fetus, placenta, fetal membranes, and amniotic fluid more than to a change in metabolism; Increased water retention r/t increased aldosterone |
| Respiratory changes | O2 consumption inc. by 20%; mom's need for O2 inc.; Inc resp effort, dec. PCO2 d/t progesterone; mucous mem engorged > stuffiness & epistaxis; level of diaphragm displaced as much as 4cm upward; mild hyperventilation >resp alk>Inc urinary output |
| If mom has a stuffy nose | do not take OTC meds for congestion |
| Circulatory changes (blood vol) | Inc. 30-50%; Inc begins by the end of the 1st trimester & peaks by 24-30th wks |
| Circulatory changes (pulse) | Inc. 10-15 bpm |
| Circulatory changes (BP) | slightly inc 1st trimester; drops 2nd trimester - r/t lower peripheral resistance; returns to normal during 3rd trimester |
| Circulatory changes (placement of heart) | gets displaced to a transverse position to the right by 2 degrees |
| Postural hypotension can occur r/t | increased blood volume in lower legs |
| During last trimester, blood flow to lower extremities may be impaired by | pressure of the uterus on veins and arteries - leads to edema, varicosities of the vulva, rectum & legs |
| Vena Caval Syndrome | the enlarging uterus presses on the vena cava when the pregnant woman lies supine - it decreases blood to the right atrium |
| S/S of vena caval syndrome | dizziness, rapid pulse, diaphoretic |
| LMP | The date of the first day of the Last Menstrual Period |
| EDC | Naegles rule to determine the estimated date of confinement |
| Gestation | Literally "pregnancy" |
| Gestational age | # of weeks since LMP |
| Gravida | A pregnant woman |
| Primigravida | Woman pregnant for the first time |
| Multigravida | Woman pregnant for 2 or more times |
| Para | A woman who has delivered offspring who reached the age of viability |
| Nullipara | Woman who has never delivered her 1st baby over 20 weeks |
| Primipara | Woman who has delivered her 1st baby over 20 weeks gestation (primip) |
| Multipara | Woman has delivered more than one neonate after the age of viability |
| Abortion | Delivery of a fetus at 20 weeks gestation or less (can be spontaneous - miscarriage or elective) |
| age of viability | over 20 weeks |
| GTPAL | Gravida/Term/Preterm/Abortion/Living |
| Term | 38-42 weeks |
| Preterm | 20-37 weeks |
| Abortion | under 20 weeks |
| Naegles Rule | LMP - 3 months + 7 days = EDC |
Created by:
okrecota
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