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OB Exam 1
OB chapter 11
| Question | Answer |
|---|---|
| basics of pregnancy | Affects ALL body systems Normal adaptations are unfamiliar & may cause concern Experiences are highly variable Prenatal is SOO important |
| Components of maternity care | Prenatal/Anterpartum Intrapartum/L&D Postpartum |
| first trimester | last menstrual period to 13 6/7 |
| second trimester | 14 weeks to 27 6/7 |
| third trimester | 28 weeks to 40 6/7 |
| presumptive signs aka | subjective |
| presumptive signs examples | Amenorrhea - most common Breast changes GI Symptoms Excessive fatigue Urinary frequency Quickening |
| breast changes are | due to estrogen, commonly tenderness |
| amenorrhea is due to | combination of high estrogen and progesterone |
| first presumptive sign is | fatigue which is due to increased progesterone and lower blood glucose and BP |
| urinary frequency is due to | hormonal issues |
| quickening | first time feeling the baby |
| probable signs aka | objective |
| probable signs examples | Positive pregnancy test Cervix & Uterine changes Ballottement Braxton Hicks Hyperpigmentation |
| Ballottement | physical exam when you gently tap or push against the cervix or lower uterus, causing the fetus to move away and then rebound back, producing a sensation felt by the examiner |
| braxton hicks | tightening or underlying uterine muscle |
| hyperpigmentation | darkening of the skin caused by increased levels of estrogen and progesterone |
| positive signs aka | diagnostic |
| positive signs examples | Auscultation of fetal heart tones Ultrasound visualization of fetus Fetal movement felt by a HCP after 20 weeks |
| when is the earliest you can auscultate the FHT | as early as 8-10 weeks |
| ultrasound | actually showing the baby and the heartbeat |
| pregnancy tests are | NOT DIAGNOSTIC |
| pregnancy test considerations | serum vs. urine Home kits are highly accurate but should be confirmed by doppler Certain foods, meds can affect result first void in the morning |
| details of pregnancy tests | they detect hcG <5 is negative >25 is positive normal pregnancy - levels double ~ 2 days |
| uterus repro adaptations | Size, shape, position |
| uterus repro adaptations - 12 wks | rise out of pelvis |
| uterus repro adaptations - 20 wks | level of umbilicus |
| uterus repro adaptations - 36 wks | xiphoid process |
| cervix repro adaptations | softening of cervix increased vascularity formation of mucus plug |
| softening of cervix | Goodell sign, due to increased vascularity and edema |
| increased cervical vascularity | causes the cervix to appear bluish or purplish, Chadwick sign |
| formation of mucus plug | the plug forms to keep the uterus safe and then falls out when fetus drops, helps protect from infection |
| vagina repro adaptations | hypertrophy increase in whitish/yellowish discharge |
| hypertrophy vaginal repro adaptations | increase in size as fetus moves in |
| breast repro adaptations | enlarge, stretch marks, tender colostrum by 3rd trimester hormones prepare breast for BF! |
| inferior vena cava compression syndrome | occurs when mom lays on her back, reducing blood flow back to heart causing decreased cardiac output and blood pressure |
| cardiovascular system in pregnancy: blood volume | increases by 50% corresponding changes to VS |
| HR, CO, and BP during preg | increase HR 8-10pts increased CO slightly decreased BP |
| cardiovascular system in pregnancy: hypercoaguability | clotting factors increase in pregnancy because Thromboembolisms are a real concern, especially in postpartum decrease in Hct so iron is given to mom |
| cardiovascular system in pregnancy: physiologic anemia | Increased RBCs but hemodilution! Plasma volume increases disproportionately to RBC |
| implication of hemodilution is the decrease of | Hct and Hgb |
| GI tract: repro changes | Mouth - Gums Excess salivation Slowed gastric emptying which means nausea!! |
| why is there slowed gastric emptying | increase in progesterone causing relaxed GI smooth muscle and leading to slower digestion and gastric emptying |
| morning sickness during pregnancy due to | rising levels of HcG Self-limiting by 12 weeks Sights, smells may trigger |
| what can make morning sickness worse | large meals, strong odors, empty stomach or hunger, motion, fatigue or stress |
| PICA | cravings due to changing sense of taste and low iron things that have no nutritional benefit |
| most common PICA cravings | ice, dirt, clay, paper, chalk |
| respiratory system changes during pregnancy | oxygen demand dyspnea |
| oxygen demands changes | increased because placenta is pushing on diaphragm pulmonary congestion is secondary to increased blood volume and increased vascularity in resp tract tidal volume INCREASES |
| high risk populations for respiratory changes | obese, vapers/smokers, asthma, COPD, resp infections |
| dyspnea is common in | first trimester and 2nd trimester due to increased oxygen needs later in pregnancy due to mechanical issue |
| renal/urinary changes | ↑ Blood volume → ↑ renal blood flow → ↑ GFR by 50% → more filtration and urine production |
| renal/urinary system risk | risks of UTI increases urinary stasis as flow rate decreases, ureters can twist which also increases UTI risk |
| frequency and incontinence during pregnancy | Frequency in 1st and 2nd trimester d/t increased blood volume Later pregnancy – mechanical issue stress incontinence from pressure on bladder by uterus as well as relaxed pelvic floor muscles |
| musculoskeletal system changes | center of gravity changes pelvic ligaments curvature of spine |
| center of gravity changes results in | lower back pain!!! Postural changes occur as the uterus enlarges and the center of gravity shifts forward |
| pelvic ligaments | relax and become more flexible due mainly to increased relaxin and progesterone, causes waddling gait |
| curvature of spine occurs because | the growing uterus shifts the center of gravity forward, causing the body to compensate by leaning backward |
| integumentary system changes | melasma linea nigra striae gravidarum angiomata palmar erythema hemorrhoids caused by constipation |
| melasma | Dark, blotchy pigmentation on the face, |
| linea nigra | dark line that appears down the middle of the abdomen |
| striae gravidarum | Stretch marks caused by stretching of the skin |
| angiomata | Small, red, spider-like blood vessels that can appear due to increased estrogen and vascular changes |
| palmar erythema | Redness of the palms, caused by increased estrogen and increased blood flow |
| other changes during pregnancy | leg cramps restless legs syndrome sleep alterations mental/emotional changes |
| placental hormones | Human Chorionic gonadotropin Prolactin Human placental lactogen or human chorionic somatomammotropin Estrogen Progesterone Relaxin |
| when does insulin resistance start | 24-28 weeks |
| increase in cardiac volume, HR and hemodilution causes | anemia |
| Insulin resistance occurs during pregnancy because | placental hormones make the mother's cells less responsive to insulin |
| key points of pregnancy nutrition | Diet affects fetus growth, development, & wellbeing Associated with pregnancy outcomes Supplements are routinely prescribed!! |
| pregnant people are susceptible to | iron deficiency folic acid deficiency constipation |
| iron deficiency so iron supp needed | maternal anemia! needed for blood volume expansion essential for fetal brain devlp |
| folic acid deficiency so FA supp needed | prevention of neural tube defects incorporated into prenatal vitamins |
| constipation occurs so | increase water high-fiber foods walking / exercise stool softeners |
| key diet recs during 1st trimester | no major changes to caloric intake add prenatal vitamins & iron supplements |
| key diet recs during 2nd & 3rd trimester | increase caloric intake by 300-500 calories / day over the recommended 1800-2200 cal/day |
| weight gain recs for underweight | if BMI <18, gain 28-40 lbs |
| weight gain recs for normal | if BMI <18.5-24.5, gain 25-35 lbs |
| weight gain recs for overweight | if BMI <25-29.9, gain 15-25 lbs |
| weight gain recs for obese | if BMI >/=30, gain 11-20 lbs |
| food safety considerations | minimal use of artificial sweeteners, caffeine consumption prevent listeriosis Moderate consumption of fish to avoid mercury --- avoid certain types of fish NO alcohol |
| how to prevent listeriosis | washing hands frequently refrigerating all perishable foods heating hot dogs & luncheon meats to “steaming hot!!” avoiding soft cheeses (e.g., brie) Avoid raw milk & store prepared salads |
| diet considerations for preg adolescents | Require more calories “war” for nutrition Prone to SGA babies |
| diet considerations for preg vegan/vegetarians | adapt recommendations to meet cultural framework and preferences ensure it is well-balanced refer to dietician |
| diet considerations for preg PICA | craving for non-nutritive substances can be dangerous • SOIL / CLAY • ICE • STARCH |
| maternal emotional responsess | ambivalence introversion acceptance body image changes mood swings mental health conditions |
| ambivalence | a normal emotional response where you feel two opposite things at the same time, such as joy and worry |
| introversion | opening never as small |
| sexuality | physical changes may result in less desire for sex may produce stress on relationships normalizing conversations is impt sex is safe in low-risk pregnancies |
| partner | nursing care must focus broader to birthing parents partner views are highly variable IPV (Intimate Partner Violence) may increase Couvade syndrome is real! |
| siblings | Reactions will vary based on developmental age Regression & behavioral problems common Education & preparation are key |
Created by:
leh195