MCN lecture: Antepartum (mother)

Question 1

Enumerate the signs and symptoms under “presumptive”

Answer 1

Period absent (amenorrhea)
Really tired (fatigue)
Enlarged breasts
Sore breasts
Urinary frequency increased
Movement perceived (quickening)
Emesis & nausea
Drawings on body (linea nigra, striae gravidarum, melasma)

Question 2

Enumerate the signs and symptoms under “probable”

Answer 2

Positive pregnancy test (high hCG levels)
Rebound of fetal presenting part (ballottement)
Objective
Braxton-Hicks contractions - painless practice contractions
A softening of the cervix (Goodell’s)
Bluish-purple discoloration of vulva, vagina, and cervix (Chadwick’s)
Lower uterine segment soft (Hegar’s)
Evidence (gestational sac on UTZ, fetal outline through Leopold’s); Enlarged uterus

Question 3

Enumerate the signs and symptoms under “positive”

Answer 3

Fetal movement palpated
Electronic device (Doppler) detects FHT
The delivery of the baby
Ultrasound detects fetal outline
Seeing visible movements in ultrasound

Question 4

What are the changes in the cardiovascular system that a pregnant woman undergoes? (7)

Answer 4

• Increased total blood volume
• Increased heart rate, cardiac output
• Cardiac deviation, slight cardiomegaly
• Blood pressure changes with positioning
• Increased total plasma volume
• Increased RBC, WBC count
• Hypercoagulable state

Question 5

a. Total blood volume increases by how many percent?

b. Why does it increase?

Answer 5

a. 30-50%

b. To maintain 2 circulatory systems (mother and baby)

Question 6

Recommended positioning for pregnant women to prevent supine hypotension syndrome

Answer 6

Left lateral position

Question 7

Why does vasodilation occur in pregnant women?

Answer 7

To maintain blood pressure

Question 8

a. Give the Hgb range for physiologic anemia.
b. Give the Hgb range for pathologic anemia.
c. Give the normal Hgb range for women.

Answer 8

a. 10.5 - 12 g/dL
b. < 10.5 g/dL
c. 12-16 g/dL

Question 9

Dietary sources of iron

Answer 9

Green leafy vegetables
Dark meat
Organ meat

(the darker the food, the more iron content it has)

Question 10

Why is it recommended to take iron supplements during the 2nd trimester?

Answer 10

RBC is increased, and iron is able to bind to them more effectively

Question 11

In the third trimester, a pregnant woman’s WBC count may increase up to?

Answer 11

11,000-12,000/mm^3

Question 12

What causes the pregnant woman’s hypercoagulable state?

Answer 12

Increased estrogen

Question 13

What are the changes in the alimentary system that a pregnant woman undergoes? (4)

Answer 13

• Increased oral cavity pH
• Risk for gum bleeding
• Decreased GI motility
• Nausea and vomiting

Question 14

What causes the decreased GI motility in pregnant women?

Answer 14

Progesterone (muscle relaxant)

Question 15

Management for constipation (3)

Answer 15

• High fluid intake (3L/day)
• Exercise
• Stool softeners (e.g., Colace) as a last resort

Question 16

Management for reflux due to big uterus (4)

Answer 16

• Upright position 30-60 mins after eating
• Small frequent feedings (6 smaller meals)
• Avoid fatty food since it is hard to digest
• Antacid (Maalox = safest)

Question 17

Management for nausea and vomiting (3)

Answer 17

• Dry carbohydrates, ice chips
• Small frequent feedings
• Avoid aversions

Question 18

What are the changes in the renal and urinary system that a pregnant woman undergoes? (4)

Answer 18

• Increased GFR
• Dilation of ureters
• Increased urinary frequency
• Vaginal pH becomes slightly more alkaline

Question 19

Effect of increased GFR on sugar?

Answer 19

Sugar is filtered out better and shows up in the urine (does not necessarily mean gestational DM)

Question 20

Cause of increased urination on:

a. 1st trimester?
b. 3rd trimester?

Answer 20

a. Increased cardiac output

b. Increased pressure on bladder by uterus

Question 21

An alkaline vaginal pH may increase the risk of? (2)

Answer 21

Candidiasis, vaginal infection

Question 22

What are the changes in the respiratory system that a pregnant woman undergoes? (3)

Answer 22

• Increased RR, tidal volume
• Shortness of breath due to diaphragm displacement
• Hyperemia, edema of nasal mucosa

Question 23

What are the changes in the musculoskeletal system that a pregnant woman undergoes? (3)

Answer 23

• Lordosis
• Waddling gait
• Decreased total calcium

Question 24

What hormone causes the waddling gait?

Answer 24

Relaxin

Question 25

Dietary sources of calcium (2)

Answer 25

• Dairy products

- Fish

Question 26

What are the changes in the cutaneous system that a pregnant woman undergoes? (3)

Answer 26

• Darkening of the skin
• Linea nigra
• Striae gravidarum

Question 27

What is the difference between chloasma and melasma?

Answer 27

Chloasma - darkening of face

Melasma - darkening of other parts of the body

Question 28

What are the changes in the peripheral vascularization of a pregnant woman? (2)

Answer 28

• Edema

- Varicosities

Question 29

True or false: edema is normal in the lower extremities during pregnancy.

Answer 29

True; caused by pressure of gravid uterus

Question 30

True or false: edema on face and upper extremities is normal during pregnancy.

Answer 30

False; may indicate pre-eclampsia

Question 31

Pre-eclampsia indicators (3)

Answer 31

• Hypertension
• Proteinuria
• Edema

Question 32

Areas where varicosities in pregnant women are common (3)

Answer 32

• Legs
• Rectum (in the form of hemorrhoids)
• Vagina

Question 33

Weight gain of pregnant women:

a. in the first trimester?
b. in the 2nd and 3rd trimester?

c. What is the total weight gain of pregnant women?

Answer 33

a. 1 lb per month
b. 1 lb per week

c. 25-30 lbs