Module 3 Unit A, learning guide questions Flashcards
what symptoms might make a person suspect they are pregnant
Amenorrhea
Breast tenderness, enlargement, tingling, changes in shape/color
fatigue
nausea/vomiting
urinary frequency, nocturia
perception of fetal movement
pigmentation changes
sustained basal body temperature.
What signs might make a clinician suspect a patient is pregnant
Enlargement of abdomen or uterus
Pelvic exam changes
Chadwicks, Goodell’s, Hegar’s or Piskacek signs
Ballottment
Palpation of fetal outline, fetal movements or uterine contractions
Positive pregnancy test
How does a clinician definitively diagnose pregnancy
Audible fetal heart tones
Sonographic evidence of pregnancy
when should a clinician use urine pregnancy testing vs serum pregnancy testing
As a qualitative, point of care urine test
Why is a false negative urine pregnancy test more likely than a false positive urine pregnancy test
False negatives are much more common, especially when the test is done too early after conception.
How can quantitative beta hCG patterns assist in clinical decision-making
Generally, by 4 weeks gestation (18-22 days post-conception), in a healthy pregnancy, hCG doubles approximately every 2-3 days and continues this pattern until it reaches 100,000 mIU/mL (usually between about 7 and 10 weeks of pregnancy) at which time the level plateaus and then begins to decline. This general pattern can provide clinical information, particularly when levels are measured serially every 2-3 days, but those data almost always require corroboration with other assessments.
How do you calculate an estimated date of birth using menstrual dates/Naegele’s rule
What factors must be present for that calculation to be accurate
- Naegele’s Rule: LMP + 7 days - 3 months + 1 year = estimated date of birth
- Has a known LMP
Has regular cycles
Did not conceive on hormonal
contraception or while breastfeeding
Has a clinical picture that fits
In which clinical situations is ultrasound-based pregnancy dating clinically preferable
The person cannot remember the first day of last menstrual period
The last menstrual period was unusual in some way (shorter, longer, lighter, heavier than expected or came at a time different than it was expected)
The person conceived while using hormonal contraception
The person was breastfeeding at the time of conception
There is a question about the health or development of the pregnancy because the person is spotting, the uterus is smaller than expected, or pregnancy symptoms have stopped unexpectedly. An ultrasound would then be for dating and for assessing the health of the pregnancy.(those are different by more 5 days and the person is less than 8 6/7 weeks), use the ultrasound based EDB
When should you change an estimated date of birth based on a subsequent ultrasound
(those are different by more 5 days and the person is less than 8 6/7 weeks), use the ultrasound based EDB
How will you incorporate shared decision-making in the decision about menstrual vs ultrasound dating
In today’s society, early ultrasounds are often expected. For clinicians who decline to offer a dating ultrasound, there is a risk of harming the relationship with the pregnant person.
While we do not have definitive evidence of safety of early ultrasounds (which would be extremely difficult to attain with high-quality research), decades of experience in ultrasounds has not shown harms.
Seeing their embryo/fetus on ultrasound can provide an opportunity for bonding with the pregnancy or allay anxieties about the health of the pregnancy.
Because first trimester ultrasound-based dates are considered to be more accurate (across large populations) than menstrual-based dates, routine early dating ultrasounds have the potential to decrease late-pregnancy concerns like unnecessary postdates inductions.
How will your bimanual exam results to assess gestational age in the first trimester
Presumptive
Subjective: what a woman reports
Probable
Objective: detected by physical exam or lab
Positive
Confirms pregnancy
Cannot be due to anything other than pregnancy
