ch. 4 from notes

• -through pregnancy
• -prenatal period
• -begins with conception
• -ends with onset of labor

routine physical exam and health screening

• underweight-bmi less than 19.8 gain 28-40 lbs
• average-bmi 19.8-26.0 gain 25-35
• overweight-bmi 26.1-29 gain 15-25
• obese-bmi greater than 29 gain 15

• increased risk for:
• -spontaneous abortion (miscarriage)
• -gestational diabetes
• -preeclampsia (rise in maternal bp)
• -labor induction
• -cesarean birth
• -poor wound healing
• -high risk of fetal anoloties

• folic acid
• calcium and vit. d
• magnesium
• iroin

• -linked to low birth weights, prematurity
• higher rates of neonatal mortality, spontaneous abortions, stillborn, etc

linked to fetal alcohol syndrome with resultant mental retardation and growth deficiencies, no minimum safe levels!

prevents back strain and increases abdominal muscles.

• -hormonal contraception: need 2-3 menstrual cycles before attempting to conceive
• -depo-provera: takes several months or more to conceive, possibly up to a year
• -iud: wait 1 month before attempting to conceive

• 1) presumptive signs
• 2) probable signs
• 3) positive signs

• -subjective
• -amenorrhea
• -nausea and vomiting
• -excessive fatigue
• -urinary frequency
• -breast changes
• -quickening

• -objective
• -changes in pelvic organs
• -Goodells sign
• -Chadwicks sign
• -Hegars sign
• -enlargement of abdomen
• -hyper pigmentation of the skin
• -ballottement
• -positive preg. tests
• -clinical preg. tests
• -OTC preg. tests

bluish purple coloration of the vaginal mucosa, cervix, and vulva seen at 6-8 weeks

softening of the cervix and vagina with increased leukorrheal discharge; palpated at 8 weeks

softening of the lower uterine segment; palpated at 6 weeks

• -Melasma (chloasma): mask of pregnancy, brownish pigmentation over the forehead, temples, cheek and upper lip
• -Linea Nigra: dark line that runs from the umbilicus to the pubes
• -darkening of the nipples and areola

light tap of the examining finger on the cervix that causes the fetus to rise to rise in the amniotic fluid and then rebound to its original position- occurs at 16-18 weeks

• objective signs that can be attributed by the fetus
• -FHR 10-12 weeks
• -palpation of the fetus
• -sonographic visualization

LMP-3 months+7 days=EDB

• Nageles rule
• quickening
• fetal heart beat(8-12 weeks)
• ultrasound
• -fetal sac (5-6 weeks)
• -fetal heart activity (6-7 weeks)
• -BPD measurements (12-13 weeks)

• 1: LMP-12 weeks
• 2: 13-27 weeks
• 3: 28-40 weeks

• fundus (top)
• isthmus (body)
• cervix (opening)
• endometrium (inside)

• -increase blood flow to uterus, placenta and breasts
• -increase blood volume (rbc's and plasma)
• -cardiac output increases
• -increase pressure on blood vessels
• -heart enlarges because of hypervalemia, shifts up and to the left

• resulting symptoms
• -increase HR
• -decrease BP
• -physiologic anemia of pregnancy
• -dependent edema
• -hemorrhoids
• -postural hypotension
• -supine hypotensive sundrome

• -o2 needs increase
• -need to oxygenate fetal and maternal blood
• -growing uterus presses on diaphragm
• -increase in tidal volume, slight hyperventilation

• resulting symptoms
• -mild SOB

• -estrogen
• -progesterone
• -prostaglandins (causes vascular engorgement and smooth muscle relaxation)

• resulting symptoms:
• -nasal stuffiness
• -epistaxis-nose bleeds

• urinary tract/ kidney changes
• -increase pressure on bladder (1 and 3 trimesters)
• -decrease bladder capacity-bladder flattens out
• -renal plasma flow increases
• -ureters elongate and dilate
• -GFR increases

• resulting symptoms:
• -urinary frequency
• -hyperemia
• -glycosuria-excrete glucose in urine
• -urinary stasis

• metabolism changes
• -smooth muscles relax (progesterone)
• -delayed gastric emptying
• -decrease peristalsis
• -cardiac sphincter relaxes
• -gallbladder empties slower
• displacement of stomach, intestines, and liver

• resulting symptoms:
• -nausea and vomiting
• -bloating and constipation
• -heartburn due to reflux
• -prone to gallstones
• -weight gain

• -pelvic joints relax (progesterone and relaxine)
• -lumbar curve accentuates
• -rectus abdominus muscle may seperate
•  
• resulting symptoms:
• -waddling gait
• -posture changes
• -lordosis
• -diastasis recti

• skin and hair changes
• -increase pigmentation
• -decrease connective tissue strength
• -increase subcutaneous blood flow
• -decrease rate of hair growth

• resulting symptoms
• -linea nigra
• -melasma (mask)
• -striae (stretch marks)
• -varicosities
• -spider nevi

• -increase need for insulin
• -pancreatic islets of Langerhans respond and increase insulin secretion. Gestational diabetes may occur if pancreas unable to function.
• -pregnancy specific hormones: increase hCG level in early pregnancy
• -after the development of the placenta, it produces most of the common pregnancy hormones
• -estrogen
• -progesterone
• -human placental lactogen (hPL)
• -relaxin

-process of the maternal immune system becoming tolerant of the foreign body

1) within the past year have you been hit, slapped, kicked, or otherwise physically hurt by anyone?

2) since you have been pregnant have you been hit, slapped, kicked or otherwise physically hurt by anyone?

3) within the last year has anyone forced you to have sexual activities?

# of times pregnant-doesnt matter with twins or triplets

any birth after 20 weeks

loss of fetus before 20 weeks

gravida, term, preterm, abortion, living

never been pregnant

1st time pregnant

pregnant more than once

length of pregnancy

while in labor

after labor

palpation of the abdomen to identify the position of the fetus