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Explain normal growth of fundus weeks 8,12,16,20,36,40

8-?
12- symphysis pubis
16- midway between symphysis pubis and umbilicus
36- xiphoid process
40- uterus sinks to lower level after fetal head descends

1

Braxton hicks contraction

Irregular painless contractions throughout pregnancy
Many don't notice until the third trimester
Women who are unsure or have more than 5 or 6 regular contractions in an hour or have other early signs or labor should call their doctor

2

Chadwick's sign

Bluish purple color of cervix extending to the vagina and labia

3

Goodell's

Cervix softens

4

Mucus plug

Blocks bacteria from getting to uterus

5

Bloody show

One of the earliest signs of labor

6

Blood volume

Increase as much as 45%
Increased plasma volume
Rbc Mass increase by 250-450
Hemodilution

7

Blood pressure

Supine hypotension- occluding vena cava or aorta
Turn to left side unless baby is in distress then turn to right side
Wedge pillow under the hip

8

5 causes of decreased systemic vascular resistance

1. Vasodialation due to progesterone and prostaglandins
2. Uteroplacental unity provides low resistance and greater area for circulation
3. Heat production causes vasodilation
4. Decreased sensitivity to angiotensin 2
5. Relaxant factors example nitric oxide

9

Melisma, cholasma

Increase pigmentation brownish patches on forehead cheeks and nose that occur as early as 8weeks due to elevate estrogen, progesterone and melanocytes-stimulating hormone

10

Changes by placental hormones

Human chorionic gonadotropin
Estrogen- stimulates uterine growth and increase blood supply, aids in developing the ductal system and associated with hyperpigmentation
Progesterone
Human chorionic somatomammotropin- increases availability of glucose
Relaxin-inhibits uterine activity, softens tissue in cervix, lengthens pubic ligaments

11

Presumptive signs

Amenorrhea
Nausea and vomiting
Fatigue
Urinary frequency
Breast and skin changes
Vaginal and cervical color changes
Fetal movement

12

Probably signs

Abdominal enlargement
Cervical softening
Changes in uterine consistency
Fetal movements at 16 weeks
Ballottement-fluid
Braxton hicks contractions
Palpating of the fetal outline
Palpating of fetal outline
Uterine soufflé
Pregnancy tests

13

Positive signs

Auscultation of fetal heart signs
Fetal movement felt by examiner
Visual of the fetus

14

Preconceptual/interconceptual care

Complete history and physical exam
Medications are reviewed and changed if necessary
Obese women to lose weight
Smoking cessation
Vaccinations varicella and hep b
Folic acid

15

Obstetric history

G pregnancies
T erm >38weeks
P remature 21-37 weeks
A bortions <20 weeks
L iving today

16

Negels rule

First day of lmp -3months +7days
Don't forget to change year

17

Lab tests done during pregnancy

Blood grouping with Rh and antibody screen(rhogam during pregnancy and after birth)
CBC, hgb, hct
Venereal disease research lab or rapid plasma regain- syphilis
Rubella titer- determine immunity
Genetic testing
Tb test
Hep B
Hbig
HIV
Pap & culture
Ua
Multiple marker screen- fetal abnormalities/ abnormal indicate chromosomal abnormalities
Glucose challenge test

18

Risk factors r/t demographics

Under 16 or over 35- increased risk for preterm labor, preeclampsia, congenital defects, infant mortality
Low socioeconomic status- increased risk for preterm or low birth weight
Multiparity-higher parity increases risk for antepartum or post partum hemorrhage, c section

19

Risk factors related to current diabetes mellitus

Preeclampsia
C section
Preterm birth
Infants small or larger for age
Neonatal hypoglycemia
Congenital abnormalities

20

Nausea and vomiting during pregnancy

Crackers before arising
Small frequent meals
Fluids separate from meals
Avoid dried greasy foods
Ginger, peppermint or combo spicy foods
Acupressure band that applies pressure to wrist or arm

21

Heart burn

Small meals avoid fatty or spicy foods, eliminate smoking, carbonated beverages, try chewing gum, do not eat before bedtime, sleep with extra pillow, walk upright after meals
Avoid bending over
Loose fitting clothes
Deep breath sip water
Anti acids as ordered by dr

22

Back ache

Correct posture head up shoulders back
Avoid high heels
Squat don't bend
Do not lift heavy objects
Use foot supports, arm rest, and pillows behind back when sitting
Exercises

23

Round ligament pain

Good body mechanics
Do not make sudden movements or position changes
Avoid stretching and twisting at the same time
Bend toward the pain, squat or bring the knees to chest to relieve pain
Apply heat or lie on the right side to relieve pain

24

Urinary frequency

Decrease fluids in the evening
avoid caffeine
Perform kugel exercises

25

Varicosities

Avoid constricting clothing And crossing knees
Rest frequently with legs elevated
Wear hoes or elastic stockings
Walk around at least every 2 hours

26

Constipation

Drink 8 glasses of liquids
Add foods high in fiber
Restrict cheese
Reduce sweets(empty calories)
Do not discontinue iron
Exercise- swimming, stationary bike, take a walk
Use a foot rest to decrease straining during elimination

27

Hemorrhoids

Avoid constipation
Take frequent tempid baths

28

Leg cramps

Elevate legs often during the day
Extend effected legs and flex feet
Avoid excessive foods high in phosphorus

29

Teaching points for first ob visit and to continue though pregnancy

Bathing- use nonskid pads d/t change in center of gravity
Hot tubs and saunas- avoid maternal hyperthermia especially In 1st trimester hot tub 10min sauna 15min
Douching- don't do it! Increased risk for bacterial vaginosis
Breast care- avoid soap on nipples gets rid of natural lubricant, wear a supportive bra, do not stimulate breasts if you have a history of preterm labor
Avoid tight clothing and high heels
Sleep and rest
Nutrition
Employment
Travel
Immunizations
Lifestyle changes