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Flashcards in 12. Prenatal Deck (50):
1

Three categories of pregnancy signs

Presumptive
Probable
Positive

2

Define "Presumptive" signs of pregnancy

Subjective changes felt by the woman -- not diagnostic (least reliable)

3

Define "Probable" signs of pregnancy

Signs, symptoms and/or changes that can be observed by an examiner. -- Not diagnostic (but more reliable)

4

Define "Positive" signs of pregnancy

Signs that cannot be attributed to anything but pregnancy-- Diagnostic.

5

Presumptive signs and symptoms (6)

• Amenorrhea
• Fatigue
• Nausea and vomiting
• Breast changes
• Urinary Frequency
• Quickening

6

Breast changes with pregnancy (Presumptive - 3)

o Tingling
o Heaviness
o Tenderness

7

Four characteristics of "Quickening"

o The feeling of fetal movement
o Often described as a “fluttering”
o Difficult to distinguish between fetal movements and peristalsis
o Occurs at 16-20 weeks

8

Probable Signs and Symptoms (8)

(don't memorize)

• Pregnancy Tests
• Chadwick’s Sign
• Goodell’s Sign
• Hegar’s Sign
• Ballottment
• Enlarged abdomen (uterine)
• Braxton Hicks Contractions
• Pigment changes -- vagina, cervix

9

Pregnancy Tests -- Accuracy

o 95-98% accurate. It is possible (but not likely) to have a false positive
o After a terminated pregnancy, your hCG levels remain elevated for a short time. (False +)

10

Chadwick's Sign

o Blue-purple discloration of the cervix

11

Goodell's Sign

o Softening of the cervix

12

Hegar's Sign (including when)

o Softening and compressibility of the lower uterine segment (isthmus) after 6 weeks gestation

13

Ballottment

o Palpate fetal body part and it “bounces back” to examiner’s hand when cervix is tapped (16-18 weeks)

14

Positive signs of pregnancy (3)

• FHT (Fetal Heart Tones)
• Visualization of fetus -- Ultrasound
• Palpating fetal movements -- Felt by the examiner

15

Serum Pregnancy Tests:
• Test for ______
• Type
• ___ days after conception

• Beta hCG
• Quantitative
• (+) by 6-11 days after conception

16

Urine Pregnancy Tests:
• Test for ______
• Type
• ___ days after conception

• hCG
• Qualitative
• (+) by 17-25 days after conception

17

Other possible causes of Amenorrhea (5)

• Emotional stress
• Strenuous physical exercise • • Endocrine problems
• Chronic disease
• Early menopause

18

Other possible causes of Nausea and Vomiting (3)

• GI virus
• Food poisoning
• Emotional stress

19

Other possible causes of Fatigue (3)

• Illness
• Stress
• Sudden changes in lifestyle

20

Other possible causes of Urinary Frequency

• UTIs

21

Other possible causes of Breast and Skin changes (2)

• Premenstrual changes
• Use of oral contraceptives

22

Other possible causes of Vaginal / Cervical Color changes (2)

• Infection
• Hormonal imbalance

23

Other possible causes of Quickening (3)

• Abdominal gas
• Peristalsis
• Pseudocyesis

24

Other possible causes of Abdominal enlargement

• Abdominal or uterine tumors

25

Other possible causes of Cervical Softening (2)

• Infection
• Hormonal imbalance

26

Other possible causes of Ballottment

• Uterine or cervical polyps

27

Other possible causes of Braxton Hicks contractions

• Leiomyomas

28

Other possible causes of Palpation of fetal outline

• Leiomyomas (large ones may feel like fetal head, small soft ones may feel like other parts of fetus

29

Other possible causes of positive pregnancy tests (4)

THINGS THAT PRODUCE hCG:
• Certain medications
• Premature menopause
• Blood in urine
• Malignant tumors

30

Other possible causes of auscultation of fetal heart sounds

None. This is a positive sign.

31

Other possible causes of Fetal movements.

None. This is a positive sign.

32

Other possible causes of visualization of embryo or fetus.

None. This is a positive sign.

33

Pseudocyesis (def)

False pregnancy

34

Leiomyomas (def)

Soft uterine fibroids

35

How to document gravidy and parity

Gravidy
Parity
• Term
• Preterm
• Abortions
• Living

36

Gravidy (def)

Number of pregnancies, regardless of outcome

37

Parity (def) - when documenting G/P

Number of times a woman gives birth beyond 20 weeks

38

Term (def)- when documenting G/P

Number of births after 37 weeks

39

Preterm (def)- when documenting G/P

Number of births before 37 weeks

40

Abortions (def) - when documenting G/P

• Def
• Two types

Pregnancies ending before 20 weeks
• SAB = Spontaneous
• VTOP = Voluntary

41

Living (def) - when documenting G/P

Children currently living

42

Components of the physical exam on 1st prenatal visit (5)

• Blood pressure
• Height and weight
• Urine dip (glucose, protein)
• Head to toe exam
• Pelvic exam

43

Nägele’s Rule (def)

Used to determine "due date" based on a woman with a "normal" cycle of approximately 28 days

44

Other ways of saying "due date" (medical - 3)

• Estimated date of birth (EDB)
• Estimated date of delivery (EDD)
• Estimated date of confinement (EDC)

45

How to calculate EDD using Nägele’s Rule

• First day of LMP
•+ 7 days
• - 3 months
• SUBTRACT A YEAR

46

Frequency of prenatal visits (three breakdowns)

• Before 28 weeks: Q 4 weeks
• 28 – 36 weeks: Q 2 weeks
• Week 36- Birth: Q 1 week
• Can be more frequent if there are complications, questions or concerns

47

What is included in prenatal follow-up visits (7 things - don't memorize)

• BP, Height and weight
• Urine dip stick
• Abdominal exam
• Patient ed: Danger sxs to report to provider immediately
• Patient ed: Sxs of pre-term labor
• Complaints
• 3rd trimester: Discuss preparation and readiness for birth

48

What is included in a prenatal abdominal exam? (4)

• Fundal height
• Fetal heart tone
• Leopold’s Maneuvers
• Fetal movement

49

10 sxs to report to provider immediately during pregnancy

(don't memorize necessarily)

• Vaginal bleeding
• Alteration in fetal movements
• Rupture of membranes
• Visual disturbances
• Swelling of face or hands
• Severe headache
• Epigastric pain
• Fever or chills
• Contractions that increase in frequency or duration prior to 37 weeks
• Persistant vomiting

50

Four steps to Leopold's Maneuver

1) Determine what fetal part is in the fundus
2) Determine location of small parts (feet, hands)
3) Determine what fetal part is presenting
4) Is there engagement?