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jwhughes
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What is a blue-purple discoloration of the cervix (mucus membranes) called
Chadwicks sign
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What is softening of the cervix called
Goodell sign
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What are purplish stretch marks that slowly turn silver after childbirth
Striae Gradidarum
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What is an anti-body rich, yellow secretion, may be expressed manually by the 12th week and may leak from the breasts during the last trimester
Colostrum
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What is an ease in flexing the body of the uterus against the cervix
McDonald's sign
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What is the position of the fundus at 10-12 weeks? at 20-22 weeks?
- 10-12: palpable just above the symphisis pubis
- 20-22 weeks: at the level of the umbilicus
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What refers to the midline of the abdomen from the pubic area to the umbilicus and above
Linea alba
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What is increased pigmentation of linea alba called when the area begins to darken
Linea nigra
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What is irregular pigmentation of the cheeks, forehead, and nose accompanied by sun exposure (mask of pregnancy)
Chloasma
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What is gravida
any pregnancy regardless of duration, including the present
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What is para
birth after 20 weeks regardless of whether infant lived or died
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When is fundal height a good indicator of uterine size? How big should it be in correlation wth weeks gestation?
- 22-34 weeks
- (if 34 weeks, then 34 cm etc)
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What things can interfere with accuracy of fundal height?
- maternal position
- maternal height
- 3rd trimester (fetal weight)
- obese women
- women with uterine fibroids
- women with hydroamnios
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What causes the uterus to increase its capacity from 10 mL to 5.1 L?
- Increase in cells (hypertrophy) in response to estrogen
- Distention of the growing fetus
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How does the cervix keep bacteria from entering the uterus
Secretes mucus that forms a plug at the opening of the endocervical canal
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What 3 reproductive organs does estrogen influence? How?
- Cervix: mucus plug
- Vagina: thicken mucus/relax connective tissue
- Breasts: enlarge and increase number
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What is the increase of cardiac output in a pregnant woman? pulse?
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What causes a decrease in blood pressure throughout the first and second trimester of pregnancy
Pulmonary and Peripheral vascular resistance decreases by 40-50%
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How can postural hypertension develop during the third semester of pregnancy
Uterus presses on pelvic and femoral vessels limiting blood return to the heart
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What can result in decreased blood flow to the right atrium and a decrease in blood pressure? How does this happen?
- Vena Cava Syndrome
- gravid uterus compresses vena cava
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How can Vena cava syndrome be prevented/treated
lay the woman on her left side with a pillow under her right hip
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A pregnant woman presents to labor and delivery complaining of dizziness. You note that she seems pale and is diaphoretic. What is this an indication of?
Vena cava syndrome
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What is the increase of blood volume for pregnant woman? RBC? Plasma?
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Why is there a decrease in HCT by 7% leading to physiologic anemia?
Due to increased blood volume, RBC, and plasma volume, the blood becomes diluted
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What does the respiratory volume increase to? what is the reason for this increase?
- 30-40%
- Decreased airway resistance in response to progesterone
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Why does the intrathoracic volume remain unchanged even though the uterus presses up to the diaphragm
The rib cage flares and the chest circumference increases
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What causes the waddling gait in pregnancy
relaxation of pelvic joint
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What can cause diastasis recti separation of the abdominal muscles?
uterus enlargment
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What causes low back pain in pregnancy
physiological lordosis as a result of the weight of gravid uterus
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What causes N/V in the first trimester
hCG increase
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What causes bloating, constipation, and gastic reflux in pregnancy
Increased progesterone levels relax smooth muscles decreasing peristalsis
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What worsens GI symptoms in pregnancy
pressure of gravid uterus on intestines
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What can cause hemorrhoids in pregnancy
constipation and increased pressure on blood vessels in the rectum
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What causes increased urinary frequency in the first trimester
gravid uterus presses on the bladder
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When is urinary urgency relieved in pregnancy and how is it relieved? When will it return?
- Second trimester
- The uterus moves into the abdominal cavity
- Third trimester
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What causes glycosuria?
GFR increases by 50% limiting the kidneys from absorbing all of the glucose
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What causes increased levels of pigmentation in the areola, nipples, vulva, etc...
estrogen
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What is an increase in pigmentation on the forehead and around the yes (aggravated by sun exposure, common in women of color)
cholasma
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What is darkly pigmented line that extends from umbilicus to pubic area
Linea nigra
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What is reddish streaks on trunk and thighs? What color do they change to after delivery
- Striae gravidarum
- shiny gray-white
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What causes striae gravidarum
Stretching of connective tissue due to increased adrenal steroid levels
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What is the recommended total weight gain for normal weight before pregnancy? First trimester? Subsequent trimesters?
- 25-35 lbs
- 3-5 lbs
- 1 lb/week
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What causes water retention in pregnancy
- increased sex hormones
- decreased serum protein
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What hormone is secreted by trophoblast early in pregnancy?
hCG
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What two hormones does hCG stimulate
estrogen and progesterone
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What is another word for chorionic somatomammotropin
Human placenta lectogen (hPL)
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What produces estrogen and progesterone for the first 7 weeks of pregnancy and later by the placenta
corpus luteum
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What stimulates uterine development to support fetal growth and stimulates the ductal system of the breast for lactation
estrogen
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Name 4 functions of progesterone
- maintain endometrium
- decrease uterine contractility
- stimulate breast achini and lobules
- relax smooth muscle causing heartburn
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What is Relaxin primarily made by
corpus luteum
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What 3 things does relaxin do
- decrease uterine contractility
- helps soften cervix
- long term effects on collagen
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What lipids found in the female reproductive system contribute to the decrease in placental vascular system and probably contribute to onset of labor
prostaglandins
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How many extra calories does a pregnant woman need?
300/day
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Describe the distribution of weight gain in pregnancy
- fetus/placenta/amniotic fluid: 11 lbs
- uterus: 2 lbs
- Increased blood volume: 4 lbs
- Breast tissue: 3 lbs
- Maternal stores: 5-10 lbs
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What is the primary nursing diagnosis related to psychosocial changes in pregnancy
Potential alteration of family processes
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What does TPAL stand for regarding para
- T: # born >37 weeks
- P: # born 20-37 weeks
- A: # abortions (spontaneous or therapeutic) before 20 weeks
- L: # children living
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Name 6 presumptive signs of pregnancy (subjective)
- amenorrhea
- n/v
- fatigue
- urinary frequency
- breast changes
- quickening (16-20 weeks)
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Name 7 probable signs of pregnancy (objective)
- Hegar's sign
- McDonald's sign
- Chadwick's sign
- Goodells sign
- Abd enlargment
- skin pigmentation changes
- fetal outline
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What is softening of isthmus of uterus called
Hegar's sign
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Name 3 diagnostic (definitive) signs of pregnancy
- Fetal heart beat
- Fetal movement felt by provider
- Visualization of ultrasound
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How do you calculate estimated due date using Nagele's rule
Subtract 3 months from LMP and add 7 days
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What method of estimating due date uses uterine size to indicate gestational age by measuring in CM the distance from the symphysis pubis to top of uterine fundus
Mcdonald's sign
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When can a doppler advice be used for fetal heart tone/minute
8 weeks
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What should the fetal heart rate normally be
120-160
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How often should a woman be seen for prenatal visits?
- 1/month until 28 weeks
- 2/month 28-36 weeks
- weekly until delivery
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What does a gush of fluid from the vagina indicate
rupture of membranes
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What can vaginal bleeding indicate in pregnancy
abruption or previa or bloody show
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What can abdominal pain indicate in pregnancy
preterm labor or abruption
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When is alpha feto-protein level checked to screen for neural tube defect
16-18 weeks
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When does mom do blood glucose challenge test
24-28 weeks
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What does the US rank in infant mortality
30th
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What is the number of deaths per 1000 live births in the first 28 days of life
neonate mortality
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What is the number of deaths per 1000 live births in the first year of life
infant mortality
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What is death from beginning of pregnancy through 6 weeks after delivery
maternal mortality
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What is poverty level for a family of 4
22,050
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What does FMLA allow for pregnant women for unpaid leave? What are the restrictions
- 3 months
- <50 employees at the job
- Worked less than 1 year
- Work <25 hrs/week
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What are fatty acids from fish and red meat important for
- placental growth
- fetal brain development
- fetal visual function
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