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OB Exam 1 Study Guide: Signs of Pregnancy, Reproductive System, and Physiologic Changes, Study Guides, Projects, Research of Obstetrics

Virginia State University (VSU)Obstetrics

This study guide provides a comprehensive overview of the signs of pregnancy, changes in the reproductive system, and physiological changes during pregnancy. It covers subjective, probable, and diagnostic signs, including changes in the uterus, cervix, ovaries, vagina, and breasts. The guide also discusses gastrointestinal and cardiovascular changes during pregnancy, including morning sickness, constipation, heartburn, and blood volume increases. It is a valuable resource for students of obstetrics and anyone interested in understanding the physiological changes that occur during pregnancy.

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OB Exam 1 Study Guide

Exam 1 OB

Signs of Pregnancy pg. 363

Subjective (Presumptive) Changes

•The subjective changes of pregnancy are the symptoms the woman experiences and reports. Because

they can be caused by other conditions, they cannot be considered proof of pregnancy

•Amenorrhea, absence of menses, is the earliest symptom of pregnancy (with regular periods). It is not

a reliable sign of pregnancy by itself, but if it were accompanied by consistent nausea, fatigue, breast

tenderness, and urinary frequency, pregnancy would be very likely.

•Morning sickness - Nausea and vomiting that occurs early in the day (1st Trimester)

-Women who experience NVP often have a more favorable pregnancy outcome than those who

do not.

•Excessive fatigue (1st & 3rd trimester)

•Urinary frequency as the enlarging uterus presses on the bladder (1st and 3rd trimester)

•Breast changes (tenderness)

•Quickening (feels like gas pains and is the moment in pregnancy when the women starts to feel/perceive

fetal movements in the uterus), occurs 16-20 weeks after the LMP

Objective (Probable) Changes

•An examiner can perceive the objective changes that occur in pregnancy. Because these changes can

have other causes, they do not confirm pregnancy.

•Changes noted in the uterus and vagina during pregnancy within the first three months of pregnancy

-Softening of the cervix (Goodell’s sign)

-Dark violet coloration of cervix, vagina, and vulva (Chadwick’s sign)

-Softening of lower part of uterus, the isthmus (Hegar’s sign)

-An ease in flexing of the body of the uterus against the cervix (McDonald’s Sign)

-Progressive uterine enlargement - Know

Discover Study Guides, Projects, Research of Obstetrics Virginia State University (VSU)

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OB Exam 1 Study Guide

Exam 1 OB

Signs of Pregnancy pg. 363 Subjective (Presumptive) Changes

- The subjective changes of pregnancy are the symptoms the woman experiences and reports. Because they can be caused by other conditions, they cannot be considered proof of pregnancy - Amenorrhea, absence of menses, is the earliest symptom of pregnancy (with regular periods). It is not a reliable sign of pregnancy by itself, but if it were accompanied by consistent nausea, fatigue, breast tenderness, and urinary frequency, pregnancy would be very likely. - Morning sickness - Nausea and vomiting that occurs early in the day (1st^ Trimester) - Women who experience NVP often have a more favorable pregnancy outcome than those who do not. - Excessive fatigue (1st^ & 3 rd^ trimester) - Urinary frequency as the enlarging uterus presses on the bladder (1st^ and 3 rd^ trimester) - Breast changes (tenderness) - Quickening (feels like gas pains and is the moment in pregnancy when the women starts to feel/perceive fetal movements in the uterus), occurs 16-20 weeks after the LMP Objective (Probable) Changes - An examiner can perceive the objective changes that occur in pregnancy. Because these changes can have other causes, they do not confirm pregnancy. - Changes noted in the uterus and vagina during pregnancy within the first three months of pregnancy - Softening of the cervix ( Goodell’s sign ) - Dark violet coloration of cervix, vagina, and vulva ( Chadwick’s sign ) - Softening of lower part of uterus, the isthmus ( Hegar’s sign ) - An ease in flexing of the body of the uterus against the cervix ( McDonald’s Sign ) - Progressive uterine enlargement - Know

o The fundus of the uterus is palpable just above the symphysis pubis at about 10- weeks’ gestation o At the level of the umbilicus at 20 to 22 weeks’ gestation o Between 24-34 weeks the height of the fundus correlates with the weeks of gestation o Note: Woman can have other things growing here that aren’t a baby such as fibroids

- Enlargement of the abdomen (2nd^ Trimester she said this is when the uterus becomes an abdominal organ)

Goodell’s sign: softening of the cervix due to estrogen and progesterone - probable sign of pregnancy
The endocervical glands secrete a thick, sticky mucus that accumulates and forms the mucous plug , which seals the endocervical canal and prevents the ascent of organisms into the uterus.
These signs occur due to hormonal changes in the woman Ovaries
Ovulation stops
Amenorrhea- suppression or absence of menstruation
Fraternal twins develop from two eggs that are released and fertilized at the same time by two different sperm
Identical twins develop from one egg that splits into two Vagina
Vaginal epithelium undergoes changes due to circulating estrogen
Chadwick’s sign: violet bluish, purplish discoloration of the vagina, cervix, vulva and mucus membrane (as early as 4 weeks)
Vaginal secretions- the ph changes from alkaline to acidic in order to protect the baby from any outside bacteria.
Vaginal secretions are called leukorrhea (Thick, white and acidic) - This happens so that the acid can kill any sperm or bacteria that try to enter but makes the woman more susceptible to candida (yeast) infections, which will show signs and symptoms of itching and irritation. Breast
Increase in size, tingling, tender, sebaceous glands (Montgomery Tubercles) enlarge, striae (reddish stretch marks that turn silver after childbirth)
Appearance- fullness, areolae darkens
There is an increase in sebaceous glands to help keep the breast moist
Colostrum production (first milk): antibody-rich yellowish milk. Milk full of protein and it is very important for the nurse to educate this to the patient. Physiologic Changes in Pregnancy pg. 367 Gastrointestinal pg. 367
Morning sickness - common in first trimester
Instruct the patient to have small meals throughout the day
Nausea and vomiting are common during the first trimester and may result from several factors, including elevated human chorionic gonadotropin (hCG) levels, relaxation of the smooth muscle of the stomach, and changed carbohydrate metabolism.
The gums become hyperemic, swollen, and friable and tend to bleed easily. This changed is influenced by estrogen and increased proliferation of blood vessels and circulation to the mouth.
The secretion of saliva may increase and even become excessive (ptyalism).
Dental plaque, calculus, and debris deposits increase during pregnancy and are all associated with gingivitis.
Elevated progesterone levels cause smooth muscle relaxation, resulting in delayed gastric emptying and decreased peristalsis. As a result the pregnant woman may complain of bloating and constipation
High fiber, increase fluids, drink something warm in the morning to stimulate the bowels, try to move around
These symptoms are aggravated as the enlarging uterus displaces the stomach upward and the intestines are moved laterally and posteriorly. The cardiac sphincter also relaxes, and heartburn (pyrosis) may occur because of reflux of acidic secretions into the lower esophagus.
Remain sited upright after eating, avoid spicy foods, eat in small portions
Hemorrhoids frequently develop in late pregnancy from constipation and from pressure on vessels below the level of the uterus.
High fiber diet and increase fluids to prevent this

The emptying time of the gallbladder is prolonged during pregnancy as a result of smooth muscle relaxation from progesterone. This, coupled with the elevated levels of cholesterol in the bile, can predispose the woman to gallstone formation. - If n/v persists past the first trimester = hyperemesis gravidarum Hyperemesis Gravidarum - Persistent and severe nausea and vomiting - Can be fatal - Can cause weight loss (which is malnutrition for the fetus and may cause IUGR), fluid and electrolyte imbalance and dehydration. Dehydration causes uterine contraction, hence is risking placing the mother in preterm labor. Would place on IV on this mom and load her with fluids. Cardiovascular
Heart position - shifts upward in transverse position
Heart increases in size because its working harder
Blood volume increases, as it is needed to provide adequate hydration to fetal and maternal tissues, to supply blood flow to perfuse the enlarging uterus, and to provide a reserve to compensate for blood loos at birth and during postpartum.
Anemia includes hemoglobin of less than 10, 3.5 million RBCs or a normal morphology with central pallor.
Cardiac output increases & Stroke volume increases
The pulse may increase by as many as 10 to 15 beats per minute between 14 to 20 weeks of gestation and persists to term
The blood pressure decreases slightly, reaching its lowest point during the second trimester. It gradually increases to near pre-pregnant levels by the end of the third trimester.
The enlarging uterus puts pressure on pelvic and femoral vessels, interfering/impeding with returning blood flow and causing stasis of blood in the lower extremities. This condition may lead to dependent edema and varicosity of the veins in the legs, vulva, and rectum (hemorrhoids) in late pregnancy. This increased blood volume in the lower legs may also make the pregnant woman prone to postural hypotension.
When the pregnant woman lies supine, the enlarging uterus may press on the vena cava, thus reducing blood flow to the right atrium, lowering blood pressure, and causing dizziness, pallor, palpitations, and clamminess. The enlarging uterus may also press on the aorta and its collateral circulation. This condition is called supine hypotensive syndrome/ vena caval syndrome/ aortocaval compression.
It can be corrected by having the woman lie on her left side or by placing a pillow or wedge under her right hip. - Your BP should not increase in pregnancy abnormal -> can be indicative of pre-eclampsia or PIH Hematologic
Plasma volume increases & RBC volume increases
Because the plasma volume increase (50%) is greater than the erythrocyte increase (30%), the hematocrit, which measures the concentration of red blood cells in the plasma, decreases slightly. This decrease is referred to as the physiologic anemia of pregnancy (pseudoanemia).
Vitamins and supplements help to prevent this
Hemoglobin decreases (take supplements such as iron)
Leukocytosis during pregnancy has no known cause but it is a normal finding. 5,600 to 12,200/mm3. Which can increase up to 25,000/mm3 or higher. - Both fibrin and plasma fibrinogen levels increase during pregnancy. Although the blood-clotting time of the pregnant woman does not differ significantly from that of the non-pregnant woman, clotting factors VII, VIII, IX, and X increase; thus, pregnancy is a somewhat hypercoagulable state. These changes, coupled with venous stasis in late pregnancy, increase the pregnant woman’s risk of developing venous thrombosis.

- As the pregnant woman’s center of gravity gradually changes, the lumbar spinal curve becomes accentuated (lordosis), and her posture changes. This posture change compensates for the increased weight of the uterus anteriorly and frequently results in low backache Central Nervous System - Pregnant women frequently describe decreased attention, concentration, and memory during and shortly after pregnancy, but few studies have explored this phenomenon. Endocrine Thyroid

The thyroid gland often enlarges slightly during pregnancy because of increased vascularity and hyperplasia of glandular tissue. Women with low thyroid levels (thyroid insufficiency) may compromise fetal neurologic development. Pituitary
Pregnancy is made possible by the hypothalamic stimulation of the anterior pituitary gland.
Follicle-stimulating hormone (FSH), which stimulates ovum growth, and luteinizing hormone (LH), which brings about ovulation. Stimulation of the pituitary also prolongs the ovary’s corpus luteal phase. This maintains the endometrium in case conception occurs.
Prolactin, another anterior pituitary hormone, is responsible for initial lactation.
The posterior pituitary secretes vasopressin (antidiuretic hormone) and oxytocin. Vasopressin causes vasoconstriction, which results in increased blood pressure; it also helps regulate water balance.
Oxytocin promotes uterine contractility and stimulates ejection of milk from the breasts (the letdown reflex) in the postpartum period. Pancreas
The pregnant woman has increased insulin needs, and the pancreatic islets of Langerhans, which secrete insulin, are stressed to meet this increased demand. Any marginal pancreatic function quickly becomes apparent, and the woman may show signs of gestational diabetes mellitus (GDM). Hormones in pregnancy: Human Chorionic Gonadotropin (hCG)
This hormone stimulates progesterone and estrogen production by the corpus luteum to maintain the pregnancy until the placenta is developed sufficiently to assume that function. Human Placental Lactogen (hPL)
Also called human chorionic somatomammotropin, human placental lactogen (hPL) is produced by the syncytiotrophoblast.Human placental lactogen is an antagonist of insulin; it increases the amount of circulating free fatty acids for maternal metabolic needs and decreases maternal metabolism of glucose to favor fetal growth. Estrogen
Estrogen stimulates uterine development to provide a suitable environment for the fetus. It also helps develop the ductal system of the breasts in preparation for lactation. Progesterone
Progesterone plays the greatest role in maintaining pregnancy. It maintains the endometrium and inhibits spontaneous uterine contractility, thus preventing early spontaneous abortion. Progesterone also helps develop the acini and lobules of the breasts in preparation for lactation. Relaxin
Relaxin inhibits uterine activity, diminishes the strength of uterine contractions, aids in the softening of the

The Mother

The way each woman meets the stresses of pregnancy is influenced by her emotional makeup, her sociologic and cultural background, and her acceptance or rejection of the pregnancy.
However, many women manifest similar psychologic and emotional responses during pregnancy, including ambivalence, acceptance, introversion, mood swings, and changes in body image.
Many women commonly experience feelings of ambivalence (doubt) during early pregnancy. This ambivalence may be related to feelings that the timing is somehow wrong; worries about the need to modify existing relationships or career plans; fears about assuming a new role; unresolved emotional conflicts with the woman’s own mother; and fears about pregnancy, labor, and birth.
These feelings may be more pronounced if the pregnancy is unplanned or unwanted. Indirect expressions of ambivalence include complaints about considerable physical discomfort, prolonged or frequent depression, significant dissatisfaction with changing body shape, excessive mood swings, and difficulty accepting the life changes resulting from the pregnancy.
Lower acceptance of the pregnancy tends to be related to unplanned pregnancy and greater evidence of fear and conflict. When a pregnancy is well accepted, the woman demonstrates feelings of happiness and pleasure in the pregnancy First Trimester - During the first trimester, feelings of disbelief and ambivalence are paramount. The woman’s baby does not seem real, and she focuses on herself and her pregnancy - Remember this is because there are yet no physical changes. Her uterus is still a pelvic organ. If she is an adolescent she may be “day dreaming” that she might have had an abortion Second Trimester - During the second trimester, quickening occurs. This perception of fetal movement helps the woman think of her baby as a separate person, and she generally becomes excited about the pregnancy even if earlier she was not. - As pregnancy becomes more noticeable, the woman’s body image changes. She may feel great pride, embarrassment, or concern Third Trimester - In the third trimester, the woman feels pride about her pregnancy and anxiety about labor and birth. Physical discomforts increase, and the woman is eager for the pregnancy to end - The woman tends to be concerned about the health and safety of her unborn child and may worry that she will not cope well during childbirth. Toward the end of this period, there is often a surge of energy as the woman prepares a “nest” for the infant. Many women report bursts of energy, during which they vigorously clean and organize their homes Psychologic Tasks of the Mother Four major tasks that the pregnant woman undertakes to maintain her intactness and that of her family and to incorporate her new child into the family system

Ensuring safe passage through pregnancy, labor, and birth. The pregnant woman feels concern for both her unborn child and herself. She looks for competent maternity care to provide a sense of control. She may seek information from literature, observation of other pregnant women and new mothers, and discussion with others
Seeking acceptance of this child by others. In this adjustment the woman’s partner is the most important figure.
Seeking commitment and acceptance of herself as mother to the infant (binding-in). The child begins to become a real person, and the mother begins to develop bonds of attachment. The mother experiences movement of the child within her in an intimate, exclusive way, and bonds of love form. The mother develops a fantasy image of her ideal child.
Learning to give of oneself on behalf of one’s child. Childbirth involves many acts of giving. The man “gives” a child to the woman; she in turn “gives” a child to him. Life is given to an infant; a sibling is given to older children of the family. The woman begins to develop a capacity for self-denial and learns to delay immediate personal gratification to meet the needs of another.

rituals and customs of a group are a reflection of the group’s values.

In many developed countries, such as the United States, Canada, England, and Germany, populations are becoming more and more ethnically diverse as the number of immigrants continues to grow.
It is not realistic or appropriate to assume that people who are new to a country or area will automatically abandon their ways and adopt the practices of the dominant culture
Consequently, the identification of cultural values is useful in planning and providing culturally sensitive care
For this reason, the nurse needs to supplement a general knowledge of cultural values and practices with a complete assessment of the individual’s values and practices
Cultural assessment is an important aspect of prenatal care.
The nurse needs to identify the prospective parents’ main beliefs, values, and behaviors about pregnancy and childbearing. This includes information about ethnic background, amount of affiliation with the ethnic group, patterns of decision making, religious preference, language, communication style, and common etiquette practices.
Once this information is gathered, the nurse can then plan and provide care that is appropriate and responsive to family needs Antepartum Nursing Assessment
1 st^ trimester: 0-12 weeks
2 nd^ trimester: 13-28 weeks
3 rd^ trimester: 29-40 weeks
Duration of pregnancy: - 9 Calendar Months - 10 Lunar Months - 280 days - (266 days from time of ovulation) - 40 weeks
At 12 weeks’ gestation the fundus can be palpated at the symphysis pubis. At 16 weeks’ gestation the fundus is midway between the symphysis and the umbilicus. At 20 weeks the fundus can be palpated at the umbilicus and measures approximately 20 cm from the symphysis pubis. By 36 weeks, the fundus I just below the xiphoid process and measures approximately 36 cm.
Baby goes up to the xiphoid process at 36 weeks. After 36 weeks it is difficult to measure the baby's size by measurement because when the head drops the baby goes back down towards the pelvis.
Nagele’s rule states that in order to get the estimated delivery date (EDD), you count back 3 months from the first day of the last menstrual period and add 7 days to that date. Common Discomforts of Pregnancy in 1 st^ **Trimester

Urinary frequency**

Cause - Pressure of growing uterus on bladder
Management - Decrease fluid intake at night - Maintain fluid intake during day - Void when feel urge - Most common during 1 st^ & 3 rd^ trimester 2. Breast enlargement and sensitivity
Cause - Effects of hormones, especially estrogen and progesterone
Management - Wear a good supporting bra with wide shoulder straps a cup size bigger 3. Nasal stuffiness and epistaxis

- HOT GIRL PANTIES HAVE TO GO! Wear cotton underwear (to absorb extra moisture) - Do not douche!!! (you’ll wash away natural bacteria) 5. Backache

Cause - Lumber lordosis that develops to maintain balance on later pregnancy
Management - Wear shoes with low heals - Walk with pelvis tilted forward - Use firmer mattress - Perform pelvic rocking or tilting - Mild discomfort = OKAY … severe discomfort may indicate premature labor 6. Flatulence
Cause - Decreased gastric motility - Pressure of growing uterus on large intestine
Management - Avoid gas-forming foods (beans, broccoli, oatmeal) - Chew food thoroughly - Engage in regular daily exercises - Maintain regular bowel routine 7. Leg cramps
Cause - Decrease serum calcium levels - Increase serum phosphate - Interference with circulation
Management - Extend affected leg and dorsiflex the foot - Elevated lower legs frequently - Apply heat to muscles - Evaluate diet and make sure she is getting enough electrolytes 8. Carpal Tunnel Syndrome
Cause - Compression of the medial nerve of the wrist - Weight gain and edema may also contribute
Management - Avoid aggravating hand movements - Elevate affected arm - Wear splints 9. Faintness
Cause - Pooling of blood in lower extremities - Anemia - Supine orthostatic hypotension
Management - Rise slowly from sitting to standing / avoid lying on her back - Evaluate H&H - Avoid hot and stuffy environments 10. Mood swings
Cause

- Hormonal

Management - Inform client and partner mood swings are normal Subsequent Prenatal Assessment – Know The recommended frequency of antepartum visits in an uncomplicated pregnancy is as follows:
Every 4 weeks for the first 28 weeks’ gestation
Every 2 weeks until 36 weeks’ gestation
After week 36, every week until childbirth Maternity is divided into three sections (Phases of Pregnancy)
Antepartum - time between conception and the onset of labor. (This is what will be on exam 1)
Intrapartum -period from the onset of true labor until the birth of the baby and placenta.
Postpartum - time from birth until the woman’s body returns to pre-pregnant state. Obstetric terms (GTPAL)
Gravida : The total number of pregnancies including the current one regardless duration
Term : The number of infants born at term - 38 weeks or more gestation
Preterm: The number of infants born after 20 weeks’ gestation but before completion of 37 weeks’ gestation
Abortion /miscarriage : The number of pregnancies that ended in either therapeutic or spontaneous abortion
before 20 weeks
Living : The number of children currently living
Note : If you have twins, it is considered ONE pregnancy during calculation Pregnancy Terminology
Gravid – The state of being pregnant
Gestation – number of weeks from the first day of the last menstrual period.
Term – normal duration of pregnancy - 38-42 weeks’ gestation
Para – birth after 20 weeks’ gestation regardless of whether the infant is born alive or dead
Primipara – woman who has had one birth at more than 20 weeks’ gestation
Multipara – woman who has had two or more births at more than 20 weeks’ gestation
Nullipara – woman who has had no births at more than 20 weeks’ gestation
Stillbirth – infant born dead after 20 weeks’ gestation
Multigravida – Woman pregnant for at least the third time or more
Nulligravida – Woman who has never been pregnant
Primigravida – woman who is pregnant for the first time
Secundigravida – woman pregnant for the second time Patient Profile The history is essentially a screening tool to identify factors that may place the mother or fetus at risk during the pregnancy. 1. Current pregnancy
First day of normal menstrual period (LMP)
Presence of complications (High BP, diabetes, asthma, etc)
Attitude towards pregnancy (she can be depressed about it)
Results of pregnancy test 2. History of previous pregnancies
Number of pregnancies and number of living children
Number of abortions

OB Exam 1 Study Guide: Signs of Pregnancy, Reproductive System, and Physiologic Changes, Study Guides, Projects, Research of Obstetrics

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OB Exam 1 Study Guide

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