What are some risk factors for pregnancy?

Pap smear
 Age
 Gravida (# of preg) / para (# of deliveries)
 race/ethnicity, religion, mariatal/family status, Blood type & Rh Factor
occupaion, education

2 Complete blood count (CBC)

Why is it important to take a family history before
pregnancy?
To determine both modifiable & non modifiable risk Serum cholesterol & glucose
factors related to family & genetic history to initiate
actions to minimize risk
Urinalysis
3
What is a healthy BMI Range?
8.5 – 24.9 HIV

4
What BMI classifies being "over weight"?
STD: syphilis, gonorrhea, Chlamydia
25-29.9
11
5 What are Presumptive Signs of pregnancy and what are
What BMI classifies one as "obese"? some examples of them?

30+
Subjective signs can be caused by causes outside of
6 pregnancy (Physiological changes perceived by the
What BMI Classifies one as underweight? woman)

BMI < 18.5

7 Amenorrhea
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
exam for risk factors & implementing interventions Increased skin pigmentation and striae
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
exam? Quickening, Fatigue
12
What are objective signs?
Height & weight to calculate BMI
Pregnancy signs that can be perceived by the healthcare
provider
Comprehensive physical exam 13
What are some examples of objective pregnancy signs?

Breast exam  Chadwick’s

 Goodell’s
Pelvic exam
 Hegar’s
10
What are the Components of a pre-conception lab
 Ballottement
exam?
  pregnancy 29 weeks through 40 completed weeks
22
 Skin changes
How many days long is a normal pregnancy?
14 280
What is Chadwick's sign, where does it occur, and how
many weeks after conception does it appear? 23
What is nagele's rule for gestional age?
 The vigina, cervix, vulva turns blue/purple in
color –First day of LMP
 Occurs after 6-8 weeks from conception
–Subtract 3 months
15
What is Goodell's sign, where does it occur, and how –Add 7 days
many weeks after conception does it appear?
–Example: LMP Nov 21
 It is a Softening & > leukorrhea of the cervix and
vagina  Subtract 3 months: August 21
 Occurs after 8 weeks  Add 7 days: August 28

16 24
What is Hegar's sign, where does it occur, and how What does the term "gravida" mean?
many weeks after conception does it appear?
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 It is a Softening of lower uterus
 Occurs after 6 weeks
total # of times a woman has been pregnant –
17
What are some positive signs of pregnancy?
without reference to # fetuses, including a current
Fetal Heart Tone pregnancy

 -What: fetal heart beat (doppler) 25

 -Where: near symphysis pubis over shoulder What does the term "para" mean?
 -When: 10-12 weeks Study These Flashcards
total # of births after 20 weeks whether alive or still
Fetal movement birth

 -What:actual movement
 -Where: below umbilicus <20 wks = abortion (spontaneous or elective)
 -When: 20 weeks
> # fetuses’ = one birth
Cardiac Visualization 26
What does each leter of the GTPAL system represent?
 What: fetal heart by ultrasound Study These Flashcards
 Where: below symphysis pubis
 When: 4-8 weeks
G Number of pregnancies (gravidity)
18
How do you determine pregnancy?
It is 1st day of the last normal menstrual period (LMP) T Term infants (>37 weeks)
to onset of labor
19
When does the 1st trimester begin? P Preterm Infants (<37 weeks)

1st day LMP through 14 completed weeks

20 A Abortions (spontaneous or therapeutic)
When does the 2nd trimester begin?
15 weeks through 28 completed weeks L Living Children
21
How long does the 3rd trimester last?
Abortions = < 20 weeks –decreased 2nd trimester
27
–back to normal by term
What does Nulli-para or gravid mean?
Study These Flashcards 35
Never pregnant or given birth What is supine hypotension syndrome?
28 Study These Flashcards
What does primigravida mean? Occurs when woman is lying on her back. Enlarged,
heavy uterus presses on the inferior vena cava causing
Study These Flashcards reduced blood flow back to the right atrium. This results
Pregnant for 1st time in:
29 –Hypotension
What does multigravida mean? –Fainting
Study These Flashcards –Dizziness
Pregnant for at least a second time
30 Keep woman on her side or upright
What does grand multigravida mean?
Study These Flashcards BP changes of concern:
Pregnant 5 or more times –Systolic 30 mmHG
–Diastolic 15 mmHG
31 –>140/90
What is the function of the corpus luteum? 36
Study These Flashcards What are some respiratory system changes seen in the
The main function of HCG is to maintain the corpus respiratory system with pregnancy?
luteum in early pregnancy by producing progesterone. Study These Flashcards
HCG generally is detectable in the maternal serum
about 7 days after conception
32 Diaphragm elevates 4 cm
What is goodell's sign?
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Transverse diameter increases 2 cm
Softening of the cervix. Feels like an earlobe.
33
What is chadwick's sign? AP diameter increases 2cm
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cyanosis of the cervix due to increase vascularity and
edema Oxygen consumption increases 15-25%

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

obstructs the cervical canal due to proliferation of the Tidal volume increases 50%
mucus glands. Mucus forms within the cervix and serves
to protect the fetus from ascending infectious bacteria
34 Respiratory rate increases slightly
What are some changes in the cardiovascular system
during pregnancy?
Increased vascularity entire upper tract
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37
 Blood Volume increases by 1600 ml What are some changes in the renal system during
 Heart Rate increases 15-20 bpm pregnancy?
 Body water increases 6-8 liters
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 Heart sounds: systolic ejection murmur
 Vascular changes:
 Renal plasma blood flow increases 50%
 GFR increases
–SVR decreases 20%
 Increased excretion:
o Bicarbonate
–PVR down 34% o Creatinine
 Dilation of renal pelves and ureters
 Arterial blood pressure:  Relaxation of bladder smooth muscle (stasis)
 If glucose >160 – may spill in urine.
  Protein in urine may indicate preeclampsia. What are some endocrine system changes during
pregnancy?
38
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What are some changes in the gastrointestinal system
with pregnancy?
Study These Flashcards Thyroid hypertrophy & increased BMR

 Salivary glands more active

 Increased vascularity in gums and mucus Increased need for glucose and insulin
membranes
 Teeth – loss of minerals
 Decreased motility and tone in stomach and Decreased tissue sensitivity to insulin
intestines
o Contributes to reflux and heartburn
o Constipation & hemorrhoids
Placental hormones present
 Function of gallbladder and liver slower
o Increased risk of gallstones
 Functional Changes:
Decreased LH and FSH
o N/V (esp 1st trimester)
o Hyperemesis gravidarum
 May require hospitalization
o Altered tastes & cravings Adrenal glands
o Increased appetite (esp 2nd trimester)
–increased aldosterone
39
What is Hyperemesis Gravidarum? –sodium regulation in urine

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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
during pregnancy? Study These Flashcards
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 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:
 Rectus abdominous
o Fibrinogen (30-50%)
 Low back pain
o Coagulation Factors (VII-X)
 Side pain
o WBC
 Leg cramps
44
41
What are some neurological system changes during
What are some integumentary system changes during
pregnancy?
pregnancy?
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 Striae gravidarum - strech marks

 Chloasma Sensory changes/compression of nerves
 Darkening of areola, vulva, & linea nigra
 Increased:
o Vascular markings Carpal tunnel syndrome due to edema
o Oily skin
o Acne
 Softening of fingernails Tension headaches

42
Numbness and tingling related to postural changes
45 Study These Flashcards
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
 current contractility
 Corpus luteum continues to produce estrogen
 and fetal movement
and progesterone for 8-10 wks
 Placenta takes over about 10 weeks
 Estrogen & progesterone stay up 50
 FSH and LH stay down What are some changes seen in the women during the
o No follicles mature
2nd trimester?
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46
Describe fatigue during pregnancy and how would you •BP may slightly decrease during 2nd trimester
treat it?
Study These Flashcards •Urine dip stick for glucose, albumin & ketones

•FHR (110 – 160 bpm)

Usually starts very early in pregnancy.
•Fetal movement = quickening

May be due to hormonal changes. •Fundal height = cm = wk gestation

•Edema lower extremities

Most women are “Super Woman”.
•Ultra sound = 18 – 20 wks to confirm EDD & anatomy
51
What are some laboratory & diagnositc tests done
Remedy: during the 2nd trimester?

–Rest and sleep more. Study These Flashcards

–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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•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

–BMI = 18.5 – 24.9 Total gain of 25-35lb . •Antibody screen for Rh – negative women

–1st trimester gain of 3-4.4 lbs

52
–2nd and 3rd trimester 1lb./wk What kind of assessment will be conducted during the
3rd trimester?
48
What is the "fundal height?" Study These Flashcards

Study These Flashcards •Focused assessment

The height of the belly measured from the top of the
symphysis pubis to the top of the uterine •Assessment of fetal well-being
fundus. Findings may differ if the women is obese, has
uterine fibroids, or has poly/oligohydramnios
•Pelvic examination
49
What is leopold's maneuvers? •Leopold’s maneuver
•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
•Laboratory tests
fathers?

•Patient education and anticipatory guidance Study These Flashcards

• 1. Announcement phase

53
–May react with joy, distress or combined emotions
What are the maternal tasks of pregnancy?
Study These Flashcards 2. Moratorium phase Thought of PG put aside:

•Ensuring safe passage for herself and her child –Fear of hurting baby with sex, Feelings of rivalry

•Ensuring social acceptance of the child by significant –Task = accepting the PG (wife and fetus)
others
3.Focusing phase – active involvement with fetus
•Attaching or “binding-in” to the child refers to the
development of maternal-fetal attachment –Task – role in L&D and parenting

•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.
56
What are some father's worries with pregnancy?
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•Financial

•Changing relationship/wife and friends

•Sexual responsiveness of wife

•Safety of wife and infant

•Role in L&D