What are some risk factors for pregnancy?

Pap smear
• Age
• Gravida (# of preg) / para (# of deliveries)
• race/ethnicity, religion, mariatal/family Blood type & Rh Factor
status, 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 BMI classifies one as "obese"? what are some examples of them?

30+ Subjective signs can be caused by causes outside

6 of pregnancy (Physiological changes perceived by
What BMI Classifies one as underweight? the 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 Increased skin pigmentation and striae
physical exam for risk factors & implementing
interventions when needed can positively impact
her current & future health – resulting in better Nausea and Vomiting, Urinary Frequency
health outcomes for women and families
9
What are the components of a pre-conception Quickening, Fatigue
physical exam? 12
What are objective signs?

Height & weight to calculate BMI Pregnancy signs that can be perceived by the
healthcare provider
13
Comprehensive physical exam 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 –Add 7 days
how 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
Fetal Heart Tone current pregnancy

• -What: fetal heart beat (doppler) 25

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

• -What:actual movement <20 wks = abortion (spontaneous or elective)

• -Where: below umbilicus
• -When: 20 weeks > # fetuses’ = one birth
26
Cardiac Visualization 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 T Term infants (>37 weeks)
(LMP) to onset of labor
19
P Preterm Infants (<37 weeks)
When does the 1st trimester begin?
1st day LMP through 14 completed weeks
A Abortions (spontaneous or therapeutic)
20
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
Study These Flashcards vena cava causing reduced blood flow back to the
Pregnant for 1st time right atrium. This results 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
The main function of HCG is to maintain the corpus in the respiratory system with pregnancy?
luteum in early pregnancy by producing Study These Flashcards
progesterone. HCG generally is detectable in the
maternal serum about 7 days after conception
32 Diaphragm elevates 4 cm
What is goodell's sign?
Study These Flashcards
Transverse diameter increases 2 cm
Softening of the cervix. Feels like an earlobe.
33
What is chadwick's sign? AP diameter increases 2cm
Study These Flashcards
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 Tidal volume increases 50%
the mucus glands. Mucus forms within the cervix
and serves to protect the fetus from ascending
infectious bacteria Respiratory rate increases slightly
34
What are some changes in the cardiovascular
system during pregnancy? Increased vascularity entire upper tract

Study These Flashcards 37

What are some changes in the renal system during
• Blood Volume increases by 1600 ml pregnancy?
• Heart Rate increases 15-20 bpm Study These Flashcards
• Body water increases 6-8 liters
• Heart sounds: systolic ejection murmur • Renal plasma blood flow increases 50%
• Vascular changes: • GFR increases
• Increased excretion:
–SVR decreases 20% o Bicarbonate
o Creatinine
–PVR down 34% • Dilation of renal pelves and ureters
• Relaxation of bladder smooth muscle
• Arterial blood pressure: (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 –sodium regulation in urine

What is Hyperemesis Gravidarum?
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excessive vomiting and weight loss with
NOTE: human placental lactogen jacks up insulin
dehydration. Not a frequent occurrence, and
sensitivity
occurs after 15 weeks from conception. She will
also complain of severe dehydration 43
What are some hematologic changes during
40
pregnancy?
What are some changes in the Musculoskeleteal
system during pregnancy? Study These Flashcards
Study These Flashcards
• 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
What are some integumentary system changes
during pregnancy?
during pregnancy?
Study These Flashcards
Study These Flashcards

• 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
 fundus. Findings may differ if the women is obese,
Numbness and tingling related to postural has uterine fibroids, or has poly/oligohydramnios
changes
49
45 What is leopold's maneuvers?
What are some hormonal changes seen in
pregnancy? Study These Flashcards

Study These Flashcards Abdominal palpation that shows the degree of:

• Chorionic villi produce hCG • uterine irritability

• hCG maintains corpus luteum • tone
o Indicator for positive test • tenderness
• Corpus luteum continues to produce • current contractility
estrogen and progesterone for 8-10 wks • and fetal movement
• 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
o No follicles mature the 2nd trimester?

46 Study These Flashcards

Describe fatigue during pregnancy and how would
you treat it? •BP may slightly decrease during 2nd trimester

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

Most women are “Super Woman”. •Edema lower extremities

•Ultra sound = 18 – 20 wks to confirm EDD &

anatomy
Remedy: 51
What are some laboratory & diagnositc tests done
–Rest and sleep more. during the 2nd trimester?
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–Exercise regularly (walking, swimming, etc.)
•Triple or quad screen (15 – 20 wks) *> =
–Usually corrects itself during 2nd trimester. chromosome & < = NTD

–Check blood count, eat healthy foods. •1 hr GTT (24 – 28 wks) if > = 3 hr GTT
47
What are some weight gain changes seen with •Hgb & HCT (24 – 28 wks) because blood volume
pregnancy? increases

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•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

–2nd and 3rd trimester 1lb./wk 52

48 What kind of assessment will be conducted during
What is the "fundal height?" the 3rd trimester?

Study These Flashcards Study These Flashcards

The height of the belly measured from the top of
the symphysis pubis to the top of the uterine •Focused assessment
•Assessment of fetal well-being •Sexual responsiveness of wife

•Pelvic examination •Safety of wife and infant

•Leopold’s maneuver •Role in L&D

•Nutritional follow-up •Ability to father

•Screening for group B streptococcus --> can lead •Disturbed feelings toward the baby
to 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
What are the maternal tasks of pregnancy?
emotions
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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 others –Task = accepting the PG (wife and fetus)

•Attaching or “binding-in” to the child refers to the 3.Focusing phase – active involvement with fetus
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