Preganancy

Question 1

Langauge

Answer 1

Can be gender based, but be aware of your own biases
use non-gendered language when possible
be aware of gender dysphoria (chestfeeding instead of breastfeeding)

Question 2

Preconception Assessment

Answer 2

Would you like to have a child in the next year?
Assess BMI, reproductive history
family history of genetic disorders
Past med/surgical history
current meds
vaccinations
scree for STIs, pap smear
Psychosocial

Question 3

Preconception teaching

Answer 3

healthy diet and exercise
avoid alcohol, tobacco and drugs
discuss occupation and enviornmental risk
folic acid supplement at leat 3 months prior to conception
dental care (risk of preterm birth with poor oral health)

Question 4

Trying to concieve?

Answer 4

Avg. menstrual cycle is 28 days
First 14 days the egg matures in follicle (FSH hormone), then the luteinizing hormone triggers the egg release (LH)
then there is a 12-24 hour window for the sperm to fertilize egg
Sperm can survive up to 3 days after intercourse in the genital tract

Question 5

Placenta

Answer 5

produces 4 hormones to maintain pregnancy and support for embryo and fetus
Human chriorionic
ganadotropin
Human placental lactogen (hPL)
Progesterone and estrogen

Question 6

Signs of pregnancy

Answer 6

presumptive-experienced by women
amennorhea, nausea, fatigue, breast tenderness
Probable-detected by examiner (enlarged uterus)
Positive-objective evidence of fetus-auscultation of fetal heart tones and ultrasound

Question 7

Nagele’s rule

Answer 7

determined gestational age
expected date of delivery
a typical pregnancy lasts 40 weeks
(starts with the first day of the last menstrual period as day 1) add 9 months and 7 days

Question 8

Ultrasound dating very early in pregnancy

Answer 8

accurate very early in pregnancy
transvaginal early
transabdominal later

Question 9

Trimesters

Answer 9

1st Weeks 1-12
2nd Weeks 13-27
3rd Weeks 28 to birth

Question 10

Gravidity

Answer 10

Pregnancy

Question 11

Gravida

Answer 11

Client who is pregnant

Question 12

Primigravida

Answer 12

Pregnant for the first time

Question 13

Multigravida

Answer 13

Client who has had 2 or more pregnancies

Question 14

Nulligravida

Answer 14

Client who has never been pregnant

Question 15

GTPAL

Answer 15

Ontario perinatal record
insludes gravida (total # of pregnancies regardless)
Term (# of pregnancies with birth at greater than 37 weeks
Preterm (# of previous pregnancies with birth between 20 and 37 weeks)
Abortus (number of abortions prior to 20 weeks
Living children (number of living kids currently)

Question 16

Gravida

Answer 16

Number of current or past pregnancies regardless of outcomes

Question 17

Term

Answer 17

of previous pregnancies with birth after 37 weeks

Question 18

Preterm

Answer 18

Previous pregnancies with birth occurring between 20 and 36 and 6 days

Question 19

Abortus

Answer 19

Number of pregnancies ending with birth before 20 weeks

Question 20

Living children

Answer 20

how many kids are currently living

Question 21

First trimester changes

Answer 21

hormones produce changes
nausea and vomitting, fatigue
uterus changes in size and shape
fetal heart tones

Question 22

2nd semester changes

Answer 22

quickening and palpable fetal movement
breast enlargement and colostrum(thick pre milk)
linea nigra (line to top of uterus) and striae gravidarum (stretch marks)
thyroid gland and hormones
gingivitis
fetal heart tones (120-160 is normal for baby)
blood pressure
gastro changes (heartburn, changes in cravings)
Eclampsia from too high of blood pressure

Question 23

third trimester changes

Answer 23

blood volume and components
urterine enlargements
edema of lower extremities
posture and lordosis
varicosities and hemmorrhoids
engagement
lightening (dropping of stomach), mucus plug exposure

Question 24

Weight gain during pregnancy

Answer 24

depends on the BMI to start
higher BMI should not gain as much weight
25% is the fetus
11% is placenta
62% water gain and 30% fat gain and 8% protein

Question 25

Prenatal nutrition

Answer 25

determinants of health have impact on dietary intake
good nutrition before and during pregnancy is important
does mom have access and financial access to food
inadequate nutrition can lead to low birth weight and preterm babies

Question 26

Developmental considerations

Answer 26

decreasing rate of adolescent pregnancy
teen pregnancy risk in rural areas, socioeconomic groups, little family support, limited prenatal care and aboriginal communities
risk for pre-eclampsia-inadequate nutrition, substance use, stis, poverty
advanced maternal age in Canada-increase in down syndrome, increased risk for multiple fetuses, co existing medical conditions

Question 27

Cultural and Social Considerations

Answer 27

some complications of pregnancy more frequent in specific populations
complex mix of hereditary and genetic factors

Question 28

subjective data

Answer 28

menstrual history-first day of normal menstrual period
gynecological history-uterus or cervical surgery
obstetrical history-GTPAL
current pregnancy-calculate weeks of gestation
Medical history-allergies, asthma

Question 29

Health history questions

Answer 29

family history
review of systems
nutritional history
enviornmental hazards
bloooood pressssure history

Question 30

Objective Exam

Answer 30

Prep-equipment-stethescope, blood pressure cuff(every visit), centimetre measuring tape(fundal height every visit), fetosocpe and doppler(on fetus) sonometer
pelvic exam maybe beginning and end
reflex hammer (check if bp is high)
urine collection container (check for utis and protein)
urinaysis test strips
equipment for pelvic exam

Question 31

General survey

Answer 31

skin-chloasma-redness in mask shape
linea nigra
striae
mouth, neck(throid-don’t want hyperthyriodism)
breasts-size and pigmentation
heart (murmur is possible)
lungs
peripheral vascular (edema in legs, varicose veins, DVT (increased estrogen might cause this)

Question 32

Physical exam neuro and abdomen

Answer 32

neuro-deep tendon reflexes
abdomen-shape and contour
palpate fundus and measure height
palpate uterine contractions
leopold’smmanoevres fetal lie and presentation

Question 33

Fundal height

Answer 33

measure at weeks of gestation
empty bladder prior to assessment
distance from symphysis pubis to top of uterus
measured in cm
gestation-week18=gastational age

Question 34

Fetal heart tones

Answer 34

auscultate
count fetal heart rate
FHR x 1 minute=110-160
(make sure it not materal heart rate)

Question 35

BLOOD PRESSURE

Answer 35

avoid eclampsia