Prepare for your exams
Get points
Guidelines and tips
Sell on Docsity
Docsity AI

Prepare for your exams

Study with the several resources on Docsity

Earn points to download

Earn points by helping other students or get them with a premium plan

Guidelines and tips

Sell on Docsity

Docsity AI

Prepare for your exams

Study with the several resources on Docsity

Find documents

Prepare for your exams with the study notes shared by other students like you on Docsity

Search for your university

Find the specific documents for your university's exams

Docsity AINEW

Summarize your documents, ask them questions, convert them into quizzes and concept maps

Explore questions

Clear up your doubts by reading the answers to questions asked by your fellow students

Earn points to download

Earn points by helping other students or get them with a premium plan

Share documents

20 Points

For each uploaded document

Answer questions

5 Points

For each given answer (max 1 per day)

All the ways to get free points

Get points immediately

Choose a premium plan with all the points you need

Study Opportunities

Choose your next study program

Get in touch with the best universities in the world. Search through thousands of universities and official partners

Community

Ask the community

Ask the community for help and clear up your study doubts

Free resources

Our save-the-student-ebooks!

Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors

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

Virginia State University (VSU)Obstetrics

This study guide provides a comprehensive overview of the signs and symptoms of pregnancy, focusing on both subjective and objective changes. It covers key aspects of the reproductive system, including the uterus, cervix, ovaries, and vagina, outlining the physiological changes that occur during pregnancy. The guide also delves into gastrointestinal and cardiovascular changes, highlighting common symptoms and potential complications. It is a valuable resource for students of obstetrics and gynecology, providing a structured framework for understanding the physiological adaptations of pregnancy.

Typology: Study Guides, Projects, Research

2024/2025

Available from 12/29/2024

hesigrader002 🇺🇸

4.1

(43)

7.7K documents

1 / 53

This page cannot be seen from the preview

Don't miss anything!

OB Exam 1 Study Guide Review

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

oThe fundus of the uterus is palpable just above the symphysis pubis at about 10-12

weeks’ gestation

oAt the level of the umbilicus at 20 to 22 weeks’ gestation

oBetween 24-34 weeks the height of the fundus correlates with the weeks of gestation

oNote: 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)

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

Partial preview of the text

Download OB Exam 1 Study Guide Review: Signs of Pregnancy and Reproductive System Changes and more Study Guides, Projects, Research Obstetrics in PDF only on Docsity!

OB Exam 1 Study Guide Review

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)

o Braxton-Hicks contractions can be palpated most commonly after the 28 th^ week. Also termed false labor. o Uterine Soufle may be heard when the examiner auscultates the abdomen over the uterus. Soft blowing sound at the same time as the maternal pulse.

Funic souflé is the soft blowing sound of the blood pulsating through the umbilical cord which occurs at the same time as the fetus’s heart rate.
Changes in Pigmentation (linea nigra, chloasma and striae)
Fetal outline may be identified by palpation in many pregnant women after 24 weeks’ gestation - Ballottement is the passive fetal movement elicited when the examiner inserts two gloved fingers into the vagina and pushes against the cervix. This action pushes the fetal body up and as it falls back the examiner feels a rebound.
Pregnancy test - A positive hCG test is not necessarily and indicator of pregnancy because it can indicate molar masses and/or cancer, while low levels are associated with an ectopic pregnancy Diagnostic (Positive) Changes - The positive signs of pregnancy are completely objective, cannot be confused with a pathologic state, and offer conclusive proof of pregnancy - Fetal heartbeat: detectable by Doppler ultrasound as early as 10-12 weeks of pregnancy - Fetal movement: detected by echocardiography or transvaginal sonography but palpable after about 20 weeks of pregnancy - Visualization of the fetus by ultrasound examination confirms a pregnancy. The gestational sac can be observed by 4-5 weeks of gestation. Transvaginal ultrasound has been used to detect a gestational sac as early as 10 days after implantation. Fetal heart activity by 6-7 weeks. Reproductive System pg. 365 Uterus
The change is primarily the result of the enlargement (hypertrophy) of the preexisting myometrial cells in response to the stimulating influence of estrogen and the distention caused by the growing fetus.
Shows progressive growth; moves from an oval shape to a globular shape and it starts looking like a light bulb.
Hegar’s sign: softening of the lower uterine segment
Braxton-Hicks contractions: irregular uterine contractions (false contractions) that begin around the 4 th month of pregnancy and can be mistaken for true labor contractions. These contractions have no effect on the cervix.
Leopold’s maneuvers: feeling and palpating the abdomen to evaluate the position and presentation of the fetus
By 20 weeks gestation, the fundus, or top of the uterus, is at the level of the umbilicus and measures 20 cm.
The fundus reaches its highest level, at approximately 36 weeks, when it reaches the xiphoid process. Because it pushes against the diaphragm, many women experience shortness of breath.
Manipulating the uterus to determine the position of the baby - Fundus: the top of the uterus - Isthmus: Middle of the uterus - Cervix: lover uterus
Without a tape measure: - At the pelvis = 12 cm - Between the pelvis and the umbilicus = 16 cm - At the umbilicus = 20 cm Cervix
Chadwick’s Sign: bluish discoloration/dark violet in color

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

cervix, and has the long-term effect of remodeling connective tissue, which is necessary for the uterus to accommodate pregnancy Prostaglandins

Prostaglandins are lipid substances that can arise from most body tissues but occur in high concentrations in the female reproductive tract and are present in the decidua (endometrium) during pregnancy.
They are responsible for maintaining reduced placental vascular resistance. Decreased prostaglandin levels may contribute to hypertension and preeclampsia. Prostaglandins may also play a role in the complex biochemistry that initiates labor.
At the beginning of pregnancy, the synthesis of estrogen and progesterone is ensured by the corpus luteum that is maintained by hCG. The activity of the corpus luteum decreases with the beginning of the 8 th^ week in order to be entirely replaced by the placenta at the end of the 1 st^ trimester.
The corpus luteum is what produces the hormones before the placenta takes over. Metabolism - Taking iron supplements is essential for fetal growth and brain development and in prevention of maternal anemia. It is needed to form new blood cells for the expanded maternal blood volume. 27 mg of ferrous iron per day is recommended. - An increase in folic acid is essential before pregnancy and in the early weeks of pregnancy to prevent neural tube defects in the fetus. 400 to 800 mcg of folic acid per day are recommended. - Protein in diet should be increased from 60 to 80/g day, while calories should be increased by 300/day from the daily-recommended intake of 1800 to 2200. Weight
The recommended total weight gain during pregnancy for a woman of normal weight before pregnancy is 11.5 to 16 kg (25 to 35 lb)
For women who were overweight before becoming pregnant, the recommended gain is 6.8 to 11.5 kg ( to 25 lb).
Women with obesity are advised to limit weight gain to 5 to 9 kg (11 to 20 lb).
Underweight women are advised to gain 12.7 to 18.1 kg (28 to 40 lb)
During the first trimester, women whose pre-pregnancy weight is within the normal weight range, weight gain of about 3.5 to 5 lb is considered normal. For underweight women, weight gain should be at least 5 lb. For over-weight women, weight gain should be 2 lb. During the second and third trimesters, for women whose pre-pregnancy weight is within the normal weight range, weight gain should be about 1 pound per week, for those underweight then over 1 pound per week and for those over-weight a weight gain of less than 1 pound a week. Water Metabolism
The increased level of steroid sex hormones affects sodium and fluid retention.
The extra water is needed for the fetus, the placenta, amniotic fluid, and the mother’s increased blood volume, interstitial fluids, and enlarged organs. Nutrient Metabolism
Low sodium, adequate calories, increased protein
The fetus makes its greatest protein and fat demands during the second half of pregnancy, doubling in weight during the last 6 to 8 weeks. Psychological Response to Pregnancy

The Father

Initially, expectant fathers may feel pride in their virility, which pregnancy confirms, but also have many of the same ambivalent feelings as expectant mothers. The extent of ambivalence depends on many factors, including the father’s relationship with his partner, his previous experience with pregnancy, his age, his economic stability, and whether the pregnancy was planned.
They also share the experiences of pregnancy and birth with their partners First Trimester - After the initial excitement attending the announcement of the pregnancy, an expectant father may begin to feel left out. He may be confused by his partner’s mood changes. He might resent the attention she receives and her need to modify their relationship as she experiences fatigue and possibly a decreased interest in sex. He might also be concerned about what kind of father he will be. Second Trimester - The father’s role in the pregnancy is still vague, but his involvement may increase as he watches and feels fetal movement and listens to the fetal heartbeat during a prenatal visit. For many men, seeing their infant on ultrasound is an important experience in accepting the reality of pregnancy - The father-to-be’s anxiety is lessened if both parents agree on the paternal role the man is to assume Third Trimester - If the couple’s relationship has grown through effective communication of their concerns and feelings, the third trimester is often a rewarding time - If the father has developed a detached attitude about the pregnancy, however, it is unlikely he will become a willing participant, even though his role becomes more obvious. Concerns and fears may recur. The father may worry about hurting the unborn baby during intercourse or become concerned about labor and birth. He may also wonder what kind of parents he and his partner will be. Couvade
Couvade has traditionally referred to the observance of certain rituals and taboos by the male to signify the transition to fatherhood. This observance affirms his psychosocial and biophysical relationship to the woman and child. More recently the term has been used to describe the unintentional development of physical symptoms such as fatigue, increased appetite, difficulty sleeping, depression, headache, or backache by the partner of a pregnant woman. Men who demonstrate couvade syndrome tend to have a higher degree of paternal role preparation and be involved in more activities related to this preparation. Siblings
Bringing a new baby home often marks the beginning of sibling rivalry. The siblings view the baby as a threat to the security of their relationships with their parents
Because they do not have a clear concept of time, young children should not be told too early about the pregnancy
The mother may let the child feel the baby moving in her uterus, explaining that the uterus is “a special place where babies grow.” The child can help the parents put the baby clothes in drawers or prepare the baby’s room.
Consistency is important in dealing with young children. They need reassurance that certain people, special things, and familiar places will continue to exist after the new baby arrives Grandparents
Younger grandparents leading active lives may not demonstrate as much interest as the young couple would like.
In other cases, expectant grandparents may give advice and gifts unsparingly. For grandparents, conflict may be related to the expectant couple’s need to feel in control of their lives, or it may stem from events signaling changing roles in the grandparents’ own lives (e.g., retirement, financial concerns, menopause, or death of a friend).
Some parents of expectant couples may already be grandparents with a developed style of grand parenting.
Clarifying the role of the helping grandparent ensures a comfortable situation for all. Cultural Values and Pregnancy
Cultures have a universal tendency to create ceremonial rituals or rites around important life events. The

Cause - Elevated estrogen levels
Management - Avoid decongestants! - Use humidifiers, cool mist vaporizers, and normal saline drops 4. Ptyalism (the excessive spitting in pregnancy)
Cause - Unknown
Management - Perform frequent mouth care - Chew gum or suck hard candy 5. Nausea and vomiting
Cause - Unknown; although some books say its because of the hormones
Management - Avoid foods or smell that exacerbate condition - Eat dry crackers or toast before arising in the morning - Eat small, frequent meals Common Discomforts of Pregnancy in 2 nd^ **Trimester:

Shortness of breath**

Cause - Growing fetus puts pressure on the diaphragm
Management - Use extra pillows at night to keep more upright - Limit activity during the day to what they are comfortable with or less 2. Heartburn – Pyrosis
Cause - Displacement of the stomach & intestines by growing fetus
Management - Eat small, more frequent meals - Use antacids - Avoid overeating and use of spicy foods 3. Varicosities
Cause - Weight of the uterus, which causes pooling and engorgement of veins in lower extremities - Heredity, age, obesity - Increased vascularity
Management - Rest in sims’ position - Elevate legs regularly - Avoid crossing legs - Avoid tight stockings - Avoid long periods of standing 4. Leukorrhea (white vaginal discharge): If it is offensive: greenish/pink/odor = get medical tx
Cause - Increased estrogen levels
Management - Take daily bath or shower

- 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

Length of pregnancy (to help determine the length of the next one; if you had babies at 28 weeks you may deliver the next one early)
Type of birth (C-sections, vaginal) - Once a section is not always a C-section. It is safer to have a natural birth 2 years after having a C-section.
Type of anesthesia used, if any
Complications associated with childbirth, if any
Neonatal complications
Blood type and Rh factor - RH factor affects a mother who is negative. It affects mom when she becomes pregnant from a positive man. When the RH negative mother becomes pregnant, if the baby is positive and the blood gets into her blood stream her body will see that as a foreign body, and her body will build immunity and fight that blood. The first baby will be fine. It affects the next baby because they will be seen as a foreign body so she will keep aborting the rest of her babies. - ( RhoGAM shot is given at 28 weeks to protect her against any Rh-positive red blood cells from the fetus.)
Prenatal education classes and resources 3. Gynecologic history
Date of last Pap smear; results?
Previous infections
Previous surgery
Age at menarche – regularity, frequency, and duration of menstrual flow
History of dysmenorrhea
History of infertility
Sexual history
Contraceptive history 4. Current medical history
General health, including nutrition
Weight – pre-pregnant and current.
Medications and use of herbal medications - interactions can occur
Previous or presence use of alcohol, tobacco, or caffeine (these things are teratogenic and can have bad effects on the baby; a baby born to an alcoholic can have fetal alcohol syndrome or come out with seizures/ withdrawal symptoms because the baby wants drug; A baby born to a diabetic may experience hypoglycemia.)
Illicit drug use and drug allergies and other allergies - Ex: Thalidomide was given for n/v in pregnancy in the 60's; babies were born without limbs because of the effects of the drug.
Potential teratogenic insults to this pregnancy – viral, medications, X-rays, cats at home, surgery - Teratogen= Any biological, physical, chemical, or radioactive agent that causes structural or functioning damage to the fetus
Presence of chronic disease conditions such as diabetes, hypertension, cardiovascular, renal, cancer, thyroid disorder
Record of Immunizations - Ask about immunization history. For example: screening for rubella is done but not treated until after delivery. Reasons being are because these vaccinations are live viruses. If given during pregnancy, the baby will be born death.
With some vaccines the benefit outweighs the risk.
Advise pregnant women to avoid live virus vaccines (MMR and varicella) and to avoid becoming pregnant within 1 month of having received one of these vaccines because of the theoretical risk of transmission to the fetus. 5. Past medical history
Childhood diseases
Past treatment for any disease condition

Surgical procedures
Presence of bleeding disorders or tendencies (Blood transfusions) 6. Family medical history
Presence of chronic diseases
Multiple births- twins?
History of congenital disease or deformities
Cesarean births and cause, if known 7. Genetic history (patient, father of child)
Birth defects
Recurrent pregnancy loss
Stillbirth
Down syndrome, any disability
Ethnic background
Genetic disorder 8. Religious beliefs related to health care and birth
Does the woman wish to specify a religious preference on the chart?
What practices are important for her spiritual well-being?
Might some of these practices affect the child? 9. Occupational history
Occupation
Physical demands on job (you have standing jobs like retail; educate them and tell them to take short breaks and put their legs up when they can)
Exposure to chemicals or harmful substances
Do you have opportunities fro regular meals and breaks for snack? 10. Partner’s history
Age
Significant health problems
Previous or present alcohol intake, drug use, tobacco use
Blood type and Rh factor
Occupation
Educational level
How does he feel about the pregnancy? 11. Personal history
Age
Relationship status
Educational level
Ethnic background (sickle cell disease is common in blacks; Thalassemia is common in asians)
Socioeconomic status
How does she feel about being pregnant?
Any history of emotional or physical deprivation or abuse of herself or children or any abuse in her current relationship?
History of mental health problems
Support systems – important! Expected Date of Delivery (EDD, EDB,EDC) can be determined by:
Doppler ultrasound contraindicated during first trimester
Fundal height: measurement of uterine size
Naegele’s rule:
Unreliable in irregular periods
To calculate: ADD 7 days to the last period and subtract that month by 3.
11/20 --> 11/27 --> EDD: 8/
12/20/2015 --> 12/27/15 --> EDD: 9/27/
5/5/2015 --> 5/12/2015 --> EDD: 2/12/

- Labs (Hemoglobin, MSAFP, GTT) - Maternal Serum Alpha-Fetoprotein (looks for things like down syndrome, spina bifida) o Glucose tolerance test (helps diagnose gestational diabetes) - Group Beta Streptococci (GBS) Assessment of Fetal Activity and Well-Being

Some test is for screening purposes while others are diagnostic - Screening : they indicate the fetus may be at risk for a certain disorder or abnormality. For example, all women get screened for gestational diabetes but not all women have the OGTT unless for diagnostic purposes. - Diagnostic : they can diagnose the abnormality
Factors that indicate a pregnancy is at risk include: - Maternal age <16 or > - Chronic maternal HTN, preeclampsia, DM, or heart disease - Presence of Rh alloimmunization - A maternal history of unexplained stillbirth - Pregnancy prolonged past 42 weeks’ gestation - Multiple gestation (triplets?) - Previous cervical incompetence Maternal Assessment of Fetal Activity
Fetal well being is typically used to monitor fetal well being beginning at approximately 28 gestational weeks
One study of mothers with perceived decreased fetal movement identified 80% of those fetuses with intrauterine growth restriction.
A reduction of fetal movement has been associated with fetal hypoxia, fetal growth restriction, and fetal death
Although more research is needed to determine if fetal activity assessment improves neonatal outcomes, the literature does suggest that maternal monitoring does result in a decrease in perinatal mortality and decreases maternal anxiety Fetal movements count methods
They focus on having the woman keep a fetal movement record (FMR) using a technique such as the Cardiff Count-To-Ten method
Its noninvasive and lets the pregnant woman monitor and record movements easily and without expense Teaching highlights – what to tell the pregnant woman bout assessing fetal activity - Explain that movements are first felt around 18 weeks - Slowing or stopping of fetal movements may indicate further evaluation by HCP - Daily Fetal Movement Count (DFMC) or “Kick Counts” - Keep a daily record of fetal movement, beginning at about 27 weeks’ gestation - Begin counting at the same time each day about 1 hour after meals if possible - When assessing fetal activity lay in a side-lying position quietly - Movements vary but most women feel the fetal movement at least 10 times in 2 hours. - Using the DFM record, have the woman count 3 times a day for 20-30 minutes each session. If there are fewer than 3 movements in a session, have the woman count for 1 hour or more. - Explain when to contact the HCP:

- If there are fewer than 10 movements in 2 hours - If overall the fetus’s movements are slowing, and it takes much linger each day to note 10 movements - If there are no movements in the morning - If there are fewer than 3 movements in 8 hours - Describe the procedure and demonstrate how to assess fetal movements. Sit beside the woman and show her how to place her hand on the fundus to feel the fetal movement. - Frequently used in conditions that may affect fetal oxygenation - Fewer than 5 fetal movements within 1 hour warrants further evaluation; call HCP- she said in class KNOW - Women should take the Cardiff Count-to-ten score card to each parental visit for evaluation

IN WOMEN WITH MULTIPLE GESTATION, DAILY FETAL MOVEMENTS ARE MUCH HIGHER Ultrasonography/Sonogram
Use of intermittent high frequency waves to create an image of the fetus
It is noninvasive, is painless for both the woman and the fetus, and has no known harmful effects to either
Ultrasound is limited by fetal position and technician skills
An ultrasound may seem “normal” but abnormalities may at times go unrecognized
Primary reason of this is to reassure the parents and healthcare provider Indications for use: - Early identification of pregnancy – as early as 5-6 weeks - Fetal heart activity by as early as 6 weeks and fetal breathing movements by as early as 11 weeks’ gestation - Identification of more than one embryo or fetus - Measurement of the biparietal diameter of the fetal head or the fetal femur length to assess growth patterns- helps determine gestational age of fetus and detect if IUGR - Clinical estimations of birth weight- helps detect macrosomia (not within weight limits) - Detection of fetal anomalies such as facial anomalies, anencephaly, and hydrocephalus - Examination of nuchal translucency in the first trimester to assess for trisomy 21 (down syndrome) and other fetal structural anomalies - Length of fetal nasal bone- risk factor for syndrome - Identification of amniotic fluid volume (AFV) and amniotic fluid index. If the AFI > 24cm or AFV

8 then the mother is at risk for hydramnios. Woman with an AFI <5cm and AFV <2 are at risk for oligohydramnios. At 39 weeks the amniotic fluids begin to decline. Before that if any of the above happen, then it is placing the fetus at risk for unknown status, IUGR, meconium-stained amniotic fluid, and increased risk for the admission into NICU - Soft-tissue masses (tumors) can be differentiated - Location of the placenta. The placenta is located before amniocentesis to avoid puncturing the placenta. - Placenta grading. As the fetus matures, the placenta calcifies. It is the lifeline of the baby; If the placenta is not functioning or aging, the baby needs to come out; if the placenta is in the wrong place and blocking the cervix the lady may not be able to deliver vaginally; the placenta CANNOT come out before the baby. - Determination of fetal position and presentation - Detection of fetal death Trans abdominal Ultrasound

A transducer is moved across the woman’s abdomen
The woman is often scanned with a full bladder

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

Related documents

Partial preview of the text

Download OB Exam 1 Study Guide Review: Signs of Pregnancy and Reproductive System Changes and more Study Guides, Projects, Research Obstetrics in PDF only on Docsity!

OB Exam 1 Study Guide Review