Bates preg woman

  1. what drives many preg-related endocrine &metabolic changes
    Increasing levels of estradiol & progesterone & the placental hormones- esp humanchorionic gonadotropin (HCG)
  2. Stimulate lactotrophs in the anterior lobe of the pituitary gland
  3. Stores oxytocin and antidiuretic hormone (ADH)
    HCG resets receptors for thirst & ADH release- leading to ↓ in serum Na [] and sometimes polyuria
    Posterior pituitary gland
  4. Effects of estrogen on thyroxine-binding globulin & the stimulation of thethyrotropin (TSH) receptor by HCG lead to
    fluctuations in free T4 and T3 levels & TSH (normal ranges)
  5. describe the glucose levels during preg
    • ↑ insulin resistance in later preg
    • Linked to transient hyperglycemia after meals
    • Btwn meals fasting glucose levels fall bc of demands of fetal growth & ↑ peripheral use of glucose
    • Shift from carb to fat metabolism
  6. what are the hormone changes towards the end of preg?
    • ↑ in placental corticotrophin-releasing hormone & adrenal adrenocorticotrophic hormone (ACTH) produce a “state of relative hypercortisolism” that may be a trigger for labor
    • Production of CRH suggest that a placental clock determines the timing of birth
  7. what does rising progesterone do?
    • RR does NOT change
    • Tidal vol & min ventilation ↑ (C/O’s dyspnea
    • Progesterone and estradiol lower esophageal sphincter tone (Contribute to symptoms of reflux and heartburn)
    • Relaxes tone and contraction in the ureters- causing hydronephrosis, and ↑ risk of bacteriuria in the bladder
  8. what are the CV changes?
    • Erythrocyte mass & plasma vol ↑ = more blood (plas vol ↑ more – causing relative hemodilution & physiologic anemia, which can protect against blood loss during childbirth)
    • CO ↑
    • Systemic vascular resistance & BP ↓
  9. what are the musculoskeletal changes?
    • Ensues from wt gain and relaxin (hormone secreted in the corpus luteum & placenta
    • Lumbar lordosis as the gravid uterus enlarges
    • Contributing to mechanical low back discomfort
    • Ligamentous laxity in sacroiliac joints & the pubic symphysis (To ease passage of baby)
  10. when do breast become nodular?
    by 3rd mo gestation
  11. Chadwick’s sign
    ↑vascularity, vagina a bluish/ violet color
  12. why does vaginal pH become more acidic?
    • from Lactobacillus acidophilus on the ↑ levels of glycogen stored in the vag epithelium
    • Helps protect against vag infections
    • ↑ glycogen may ↑vag candidiasis
  13. Hegar’s sign
    • Palpable softening at the isthmus
    • early dx sign of preg
  14. when does the uterus rise out of the pelvic cavity?
    by 12 wks
  15. uterine wt increases from 50-70 g to:
    800-1200 g
  16. purpose of mucus plug:
    to prevent fetus from infection
  17. brownish-black pigmented line along the midline, may be visible
    linea nigra
  18. Rectus abd muscle may separate at the midline
    diastasis recti
  19. Common concerns during 1st trimester preg
    N, c/ or s/ V, breast tenderness,  tingling, wt loss, fatigue
  20. Common concerns during 2nd trimester preg
    Groin/lower abd paino   Abd striae (late 2nd or third)
  21. Common concerns during 3rd trimester preg
    Fatigue, contractions, loss of mucous plug, edema
  22. Common concerns during all trimesters preg
    • No menses (amenorrhea)
    • Heartburn
    • constipation
    • Backache
    • Urinary freq
    • Leucorrhea
  23. what appears on the cervix during preg?
    • red velvety mucosa, (cervical erosion or eversion)
    • considered nml
  24. concerns to address during prenatal visits:
    • symptoms of preg
    • maternal attitudes of preg
    • Current health: smoking, alcohol, use of illicit drugs, domestic violence
    • past ob hx; Prior complications of preg
    • past med hx
    • FH
  25. how do you Determine week of gestation by date
    • Count in wks from menstrual age (MC) (LMP) or conception age
    • Compare estimate c/ palpable size of uterus if still in pelvic cavity, or by ht of fundus if above  symphysis  pubis
  26. how do you determine expected date of delivery?
    • Naegele’s rule: add 7 days to LMP, subtract 3 mo, add 1 yr
    • Do US to confirm it
    • Accurate and improves descision making if delays in fetal growth, preterm labor, or preg beyond 42 wks
    • If pt can’t remember LMP, has irregular menses, or dating is uncertain, vaginal probe US can confirm date in 1st trimester
  27. goals of initial prenatal visit
    • Confirming the preg
    • Assessing health status of the mother & any risks for complications
    • Counseling to ensure birth of a healthy baby
  28. what diet should you recommend?
    • 300 cal, 5-10 g of protein, 15 mg of iron, 250 mg of Ca, 400-800 micrograms of folic acid
    • Prescribe a multivitamin c/ at least 400 micrograms of folic acid
    • Caution against ingesting unpasteurized dairy products, undercooked meats, & excess vit A—can be toxic
    • Seafood is controversial
  29. ideal wt gain per BMI:
    Low -- BMI <19.8
    Normal – BMI 19.8-26.0
    High – BMI 26.0-29.0
    Obese – BMI >29.0
    avg wt gain:
    • Low: 28-40lbs
    • normal: 25-35
    • high:15-25
    • Obese: ~15

    Avg: 28 lbs
  30. ideal wt gain per trimester:
    • Very little ↑1st trimester
    • Rapid ↑ 2nd trimester
    • Mild slowing of the ↑ 3rd trimester
  31. when should preg women avoid supine positions? and why?
    • after 1st trimester
    • Can compress the IVC and abd aorta- ↓ blood flow for u and baby
  32. what are immunizations safe to give during preg? what should preg women be up to date on?
    • All preg XX should be up to date on tetanus & influenza vaccs
    • Can be administered in any trimester
    • Pneumococcal, meningococcal, & hepatitis B vacc’s are safe in preg
  33. Chronic hypertension
    blood pressure is elevated >140/>90 BEFORE 20 weeks’ gestation
  34. Gestational hypertension
    blood pressure becomes elevated >140/>90 AFTER 20 weeks’ gestation
  35. "mask of preg"
  36. what could you hear when listening to the heart? is this nml or abnml?
    • venous hums
    • common in preg
    • bc of increased blood vol
    • should go away after baby is born
  37. when can Fetal movement be felt by examiner
    at 24 wks
  38. rule when measuring fundal height
    • From 20 weeks to 32 weeks, the fundal height in centimeters should approximate the number of weeks of gestation
    • Measure the fundal height from the superior portion of the pubis symphysis to the top of the fundus
  39. How and when do you auscultate fetal HR?
    what is normal fetal HR?
    • Auscultate the fetal heart rate with the Doptone (from 10 weeks) or the fetoscope (from 18 weeks)
    • The fetal heart rate will be in the 150s to 160s during the first weeks of pregnancy and in the 120s to 140s by term
  40. what initial lab work should be done?
    what should be done every consequent visit? what are you looking for?
    • Initial lab work: CBC, blood typing, hepatitis panel, HIV testing, syphilis testing, UA and cx, PAP smear, chlamydia and gonorrhea cx
    • Every consequent visit tests urine for glucose (looking for gestational diabetes), protein (looking for preeclampsia), and WBC (looking for infection)
  41. what are the special techniques?
    • First Maneuver (Upper Pole)
    • Second Maneuver (sides of the abd)
    • Third Maneuver (Lower pole)
    • Fourth Maneuver
  42. sequence of future office visits:
    • one visit is needed during the first trimester for a full H&P with the lab work·
    • During the 2nd trimester and in the 3rd trimester until 32wks, the patient is seen monthly.
    • From 32-36 weeks, the patient is seen every two weeks.
    • From 36wks- delivery, the patient is seen weekly.
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Bates preg woman
Bates preg woman ch 19