Module 4: Pregnancy Experiences Flashcards
(75 cards)
1
Q
What are the presumptive signs of pregnancy?
What signs of pregnancy are most often noticed by women?
A
- missed period
- breast tenderness
- fatigue
2
Q
What are the probable signs of pregnancy?
A
- positive pregnancy test
- Hegar’s sign: softening of lower uterine segment
- Ballottement: ability of examiner to feel a floating body within the uterus after a sharp tap on uterus
3
Q
What are the positive signs of pregnancy?
A
- hearing fetal heart
- visualizing the fetus via ultrasound
- feeling/palpating fetal movement
4
Q
What are 4 suggestions to help women deal with nausea?
A
No remedy has been found for this troublesome discomfort but some common tips that may help a woman deal with NV are:
- Eat small amounts of food every 2–3 hours.
- Avoid large meals that over distend the stomach.
– Avoid drinking fluid with meals or over distending the stomach with large amounts of fluid in between meals. - Clear fluids such as apple juice, water, clear tea, ginger ale, and peppermint tea may be easier on the stomach. In general taking herbal teas are not contraindicated; however, there is some evidence to suggest that red raspberry leaf herbal tea may cause uterine contractions.
- Avoid greasy and fatty foods.
- Try not to skip meals or let the stomach become empty.
- Eat dry, starchy snacks, such as arrowroot cookies or melba toast, first thing in the morning or when nausea occurs.
- Avoid getting over tired.
- Sleep in a well-ventilated room and get lots of fresh air.
- Avoid cooking smells that cause nausea.
- Eat what appeals to you.
- Have someone else do the cooking!
- Salty and tart foods may relieve nausea.
5
Q
How many trimesters? How long are each trimesters?
A
- first trimester: week 1 to week 13
- second trimester: week 14 to week - 26
- third trimester: week 27 - week 40
6
Q
Which weeks of pregnancy is developing embryo most vulnerable to teratogens?
A
- the first 8 weeks of pregnancy
- rapid cell division, organ system development, and rapid growth occurs in the first 12 weeks of pregnancy
7
Q
What weeks are considered antenatal care? What are the routine antenatal tests?
A
- the first trimester: 1-13 weeks
- routine blood tests: CBC, blood type, antibodies and Rh, rubella titer, hepB, STI testing
- ultrasound in the first trimester
- Integrated prenatal screen IPS
- serum integrated prenatal screen SIPS
- nuchal translucency NT
- chorionic villi sampling CVS
- non-invasive prenatal testing NIPT: screens for trisomy 21, 18, 13 —> free for women who are considered high risk
8
Q
What are 4 factors do you think influence a woman’s decision making in relation to antenatal screening?
A
- There are many factors that influence which, if any, screening tests a woman decides to pursue during her pregnancy.
- Her age, culture, religious beliefs, past experiences, family history, as well as the availability of tests would all play a role in her decision making.
- It can be very confusing when women have to balance the risk of having a child with a congenital anomaly with the risk of invasive prenatal testing such as amniocentesis.
- There is also a chance of false positives, or uncertain results which may lead to further testing.
- For some women antenatal screening may provide reassurance and for others it may increase their stress.
9
Q
What is the definition of GTPAL?
A
- Gravida: total number of pregnancies
- Term: number of pregnancies that carried term
- Preterm: the number of pregnancies that are carried from the age of viability (20 weeks) to before term (<37 completed weeks)
- Abortions: any pregnancy loss prior to the age of viability. This includes spontaneous and therapeutic abortions
- Living: the number of living children at the time of history taking
10
Q
What is GTPAL for woman pregnant for first time?
A
- G1 T0 P0 A0 L0
11
Q
What is the GTPAL for A woman is pregnant for the third time. Her first child was born preterm and died, and her second pregnancy ended at 12 weeks?
A
- G3 T0 P1 A1 L0
12
Q
What routine testing is done during the second trimester?
A
- prenatal visits with care provider once every 4-6weeks
- detailed ultrasound between 18-20 weeks gestation
- screened for gestational diabetes between 24-28 weeks gestation
13
Q
What routine testing is done during the third trimester?
A
- prenatal visits every 4-6 weeks until 30 weeks
- prenatal visits every 2-3 weeks between 30-36 weeks
- screen for group B strep (GBS) between 35-37 weeks
- ultrasound ordered if concern about fetal growth and well-being
14
Q
What are 4 assessment are done during each prenatal visit?
A
- maternal vital signs: BP may decrease, HR may increase
- urine for presence of ketones/glucose (gestational diabetes) or protein (gestational hypertension)
- weight gain: 2-2.5kg during first trimester, 0.5-1kg per week during second and third trimester
- SFH: symphysis fundal height measurement (after 20 weeks gestation): measurement corresponds to week’s gestation
- overall assessment of women’s adaptation to pregnancy
15
Q
What are the maternal and fetal risks with being underweight or overweight when pregnancy begins?
A
- severely underweight women: have preterm labour and birth LBW infants, giving birth to IUGR
- obesity women with hypertension or diabetes: likely develop gestational hypertension, preeclampsia, diabetes during pregnancy, increased risk of c-section
16
Q
What is Leopold’s maneuver? When would it be performed?
A
- used to determine the position, presentation, and engagement of the fetus in utero.
- usually performed after 36 weeks by your healthcare provider to determine your baby’s position and estimate their birth weight.
17
Q
What is the definition of maternal fetal attachment? What 3 factors influence maternal-fetal attachment?
A
- relate to the emotional tie or relationship that develops throughout pregnancy
- other factors: previous pregnancies, previous losses, use of assisted reproductive technologies, and pregnancy complications, women’s mental health
18
Q
What does untreated antenatal depression affect (3)?
A
- increase risk of post-partum depression
- negatively on the couple’s relationship,
- attachment to the infant, and
- may also affect birth outcomes
19
Q
Which week of pregnancy does the primitive fetal heart starts to beat?
A
- around 3 weeks of pregnancy
- developmentally complete by the end of the embryonic stage at approximately 8 weeks.
20
Q
What is the normal heart rate range for full term baby?
A
- from 110 to 160 beats a minute
- younger fetus has a heart rate that is higher than the more mature fetus.
- This is due to the maturing autonomic nervous system (ANS), which initially is sympathetically driven and causes a higher fetal heart rate
- slower heart rate during fetal sleep
- increased heart rate with fetal movement
21
Q
Around which weeks is fetal movement felt by mom? What is flutter in abdomen recognized as?
A
- around 15 to 20 weeks of pregnancy
- flutter senstation is “quickening”
22
Q
What happens when fetus experience oxygen deprivation?
A
- it decreases its movements to reduce oxygen demands
- shunts blood supply to the vital organs (heart and brain)
23
Q
How is the fetal movement count/test assess?
A
- fetal movement test requires her to lie down on her side for an hour and count the kicks or movements felt.
-Women who do not perceive six movements in an interval of two hours require further antenatal testing and should contact their caregivers or hospital as soon as possible
24
Q
What shape is a uterus?
A
- uterus is a pear shaped organ
- amazingly expands from approximately 3” long, 2” wide
- 1” in its non-pregnant state,
- to 500–1000 times its original size to hold a full-term fetus
25
What is the uterus composed of (4)? Which portion/part does the placenta and fetus develop in?
- upper portion: the fundus
- the body: where the placenta and fetus grow during normal pregnancy
- lower portion: narrower
- the cervix
26
What is the top of the uterus is called?
- top of the body of the uterus is called the fundus.
- The fundus is the landmark used for measuring uterine and fetal growth in pregnancy once the uterus becomes an abdominal organ around 12–16 weeks
- also the area of the uterus that is palpated when assessing labour contractions and checking the uterus after delivery
27
What shape is the cervix (part of uterus)?
- cylindrical in shape and
- has an outer and inner opening or os
- outer os: faces the vagina
- internal os: opens into the body of uterus
- in labour, the cervix thins shorten (effacement) and dilates: the outer and inner os becomes one
28
Where is the isthmus?
- between the body of uterus and cervix
- this dividing area is significant in labour: elongating and thinning out to allow passage of fetus
- in labour: the isthmus is referred as the lower uterine segment
29
What are the 3 layers that uterus can be divided into?
- inner layer or endometrium
- middle layer or myometrium
- outer layer of the uterus
30
Why does woman lying on her back cause supine hypotension?
- When a woman is lying on her back the weight of the growing uterus exerts pressure on the inferior vena cava which results in a 25-30% decrease in cardiac output which causes significant hypotension
- Supine hypotension may also result in nausea, dizziness, pallor, diaphoresis and more importantly, can decrease blood supply to the fetus
31
What cardiac/respiratory physiologic changes happens during pregnancy?
- increased blood volume
- increased cardiac output
- increased heart rate
- slight decrease in BP
- increased RBC
- increased O2 requirements
- physiologic anemia
32
What physiologic changes happens to breasts during pregnancy?
- increased fullness
- stretch marks
- development of mammary glands
- colostrum presented by second trimester
33
What physiologic changes happens to breasts during pregnancy?
- increased fullness
- stretch marks
- development of mammary glands
- colostrum presented by second trimester
34
What GI physiologic changes happens during pregnancy (3)?
- nausea and vomiting
- delayed emptying of stomach
- reflux
- decreased tone and motility in intestines
35
What are 3 renal physiologic changes happens during pregnancy?
- dilation of uterus
- increased risk of UTIs
- urinary frequency in early pregnancy/again at term
36
What are 4 reproductive physiologic changes happens during pregnancy?
- continued uterine growth
- braxton hicks contraction: around 4 months
- softening of cervix
- vaginal mucosa thickens
- leukorrhea (vaginal discharge)
- vaginal secretions more acidic
37
What musculoskeletal physiologic changes happens during pregnancy (3)?
- pelvis tilts forward
- center of gravity shift
- lordosis (curve of the lower back)
- loosening of ligaments and joints in pelvis and hips
38
Why is folate/ folic acid important in pre-conception?
During pregnancy, how much folic acid should pregnant women be taking?
- important in the pre-conception period as it is required for closure of the neural tube in the first weeks of pregnancy which is often before a woman knows she is pregnant
- During pregnancy that supplement should increase to 0.6 mg daily
39
What are some examples of folic acid dietary sources?
- meat
- fortified cereals
- legumes
- green vegetables
- oranges
40
What are 4 topics for pregnancy education sessions (from Zohar article)?
- nutrition
- exercise
- relaxation technique
- infant care and feeding
- postpartum issues: contraception
- sexuality and childbearing
- abuse issues
- parenting
41
What can be discussed in written birth plans (3)?
- women's fears or concerns
- women's beliefs,
- labour support options
- the approach to birth women prefer
42
What are 4 signs of impending labour?
- uterus sinks downward and forwards about 23 weeks before term
- more urinary frequency as heavy uterus presses on bladder
- SFH measurement decreases
- woman may start to feel low back ache and pelvic pressure and Braxton Hicks contractions may become more frequent
- descent of the fetus, late third trimester contractions, and various hormonal changes also start to soften the cervix (ripening) causing the mucous plug to be expelled
- As this plug (operculum) is loosened and expelled tiny blood vessels in the cervix may be torn resulting in the passing of “bloody show”
- a feeling that they must prepare by cleaning, shopping, and organizing their home for their baby (also known as nesting)
- women also experience a slight weight loss as their pregnancy ends
43
What is lightening?
- in first-time pregnancies, the uterus sinks downward and forward about 2 weeks before term, when the presenting part of the fetus (usually the fetal head) descends into the true pelvis.
- This settling is called lightening, or dropping, and usually happens gradually.
44
What is bloody show?
- vaginal discharge that originates in cervix
- consist of blood and mucous
45
What is prelabour rupture of the membranes (PROM)? What confirms PROM?
- the rupture of membranes before labour has started
- leakage of amniotic fluid before onset of labour
- Confirmation of PROM: evidence that fluid is leaking
46
What places a women + fetus at risk for cord prolapse?
- Prelabour rupture of the membranes (PROM)
- corp prolapse: when umbilical cord lies below or in front of the presenting fetus
47
What important assessment is done after suspected PROM occurred? What two tests is a probable indication membranes rupture?
- abdominal palpation or Leopold’s maneuvers to determine if the fetal presenting part is engaged
- nitrazine test and ferning test
48
What is the nitrazine test?
- Amniotic fluid is slightly alkaline
- probable indication that membranes have ruptured is obtained if the yellow colour red nitrazine paper turns a dark blue after contact with amniotic fluid
49
What is the ferning test?
- A ferning test is done by examining a glass slide containing amniotic fluid under a microscope. Amniotic fluid is obtained by swabbing the posterior fornix of the vagina and then rubbing the fluid onto a slide.
- Amniotic fluid has a frond-like, crystalline pattern and visualization of these “ferns” usually confirms that the membranes have ruptured
50
Once PROM has been confirmed, what can happen next?
- decision is required related to induction of labour or expectant management
- most women with ruptured membranes will go into labour within 24 hours may go home
- expectant management at home: avoid bathing in the tub, avoid intercourse, looks for signs of infection, and monitor fetal movement
51
What is preterm labour?
- Preterm labour is the occurrence of regular uterine contractions accompanied by cervical changes before 37 weeks gestation
52
What are 4 health conditions preterm infants are at risk for?
- neurologic morbidity,
- respiratory distress syndrome,
- respiratory failure,
- central nervous system hemorrhage,
- infections,
- gastrointestinal complications,
- feeding difficulties,
- problems with thermoregulation, and
- long term problems with vision, hearing, cognitive ability, growth, and behavior
53
What are 4 causes/risk factors of preterm labour?
- infection
- previous preterm birth
- periodontal disease
- working condition
- smoking, illicit drug
- stress
- Low socioeconomic status
- hypertensive disorders
- placental problems
- violence
54
What are 4 signs of preterm labour?
- menstrual like cramps,
- pelvic pressure,
- low dull backache,
- aching in thighs,
- regular contractions before 37 weeks gestation
55
What are some discomfort during the first trimester?
- breast changes: tenderness, pain, enlargement
- urgency and frequency of urination
- nausea and vomiting
- fatigue
- mood swings
- nasal stuffiness
56
What are 4 discomfort during the second trimester?
- pigmentation deepens
- spider nevi
- pruritus
- supine hypotension
- faintness
- food cravings
- heartburn
- constipation
- varicose veins
- round ligament pain
- backpain
57
What are 4 discomfort during the third trimester?
- urinary frequency and urgency
- insomnia
- ankle edema
- braxton hicks contraction
- mood swings
- SOB
- perineal discomfort
- leg cramps
58
What two hormones stimulate uterine growth in first trimester?
- estrogen and progesterone
59
Whats Hegar sign?
- at around 6 weeks of gestation,
- softening and compressibility of lower uterine segment (uterine isthmus) occurs
60
What is Braxton hicks contractions?
- after the 4th month, intermittent uterine contraction felt through abdominal wall
- are irregular and painless and cease with walking/exercise
- to enhance blood flow through intervillous space
61
What is ballottement?
- identified between 16th and 18th week
- passive movement of unengaged fetus
- a technique of palpating a floating structure by bouncing it gently and feeling it rebound
62
What is quickening?
- first recognition of fetal movement or "feeling of life"
63
What is Goodell sign?
- softening of cervical tip at about 6th week
- Goodell sign is due to the increase vascularity, slight hypertrophy and hyperplasia
64
What is Chadwick sign?
- increase vascularity results in violet-blue colour of vaginal mucosa and cervix
- at around 6-8 weeks
65
What is Striae gravidarum?
- stretch marks can appear at outer aspects of breasts
- richer blood supply to breasts cause vessel beneath the skin to dilate
- the blood vessels become visible often appearing in intertwining bluish network beneath surface of skin
66
What is lactogenesis stage I?
- during 2nd trimester, human placental lactogen (hPL) stimulate secretion of colostrum
67
What cardiovascular changes happen during pregnancy? HR? BP? Blood volume? Cardiac output?
- HR: increases by 15-20bpm
- SBP: slight or no decrease
- DBP: slight decrease
- BV: increases by 1200-1500ml or 40-50% above pregnancy level
- CO: increases by 30-50%
68
What is pica?
- nonfood cravings such as ice, clay, laundry starch
69
What is linea nigra?
- pigmented line extending from symphysis pubis to top of fundus in the midline
70
What is pruritus gravidarum?
- itching over abdomen
71
What is palmar erythema?
- pinkish red, mottled or well defined blotches seen over the palmar surfaces of the hands
72
What are the 3 phases that mother-child relationship progresses throughout pregnancy as per Rubin?
- phase 1: women accepts the biologic fact of pregnancy
- phase 2: women accepts the growing fetus as distinct from herself
- phase 3: women prepares realistically for the birth and parenting of the child
73
What is the best position for renal perfusion for pregnant women when lying down?
- side lying position increases renal perfusion: which increase urine output and decrease edema
- when pregnant women lying supine: heavy uterus compresses vena cava and aorta and cardiac output decreases
74
What is the term for the soft blowing sound heard when uterus is auscultated?
- uterine souffle
75
What is funic souffle?
- synchronous with fetal heart rate
- is caused by fetal blood coursing through umbilical cord
