Test 2 Pregnancy & Prenatal Flashcards
(123 cards)
1
Q
Which vaccine is a Live vaccine needed before pregnancy
A
MMR
2
Q
White people need Preconception testing for which disease esp.
Blacks
A
Cystic Fibrosis
1 in 25
Sickle cell
1 in 12
3
Q
Which vitamin is needed prenatal
Why?
Dosage…
A
Folic acid B9
Neural tube defects (Spinal Bifida)
400 micrograms
4
Q
1st trimester anticipated weight gain
A
4 lbs
Food aversion makes many women lose weight 1st trimester
5
Q
Tay-Sachs
Canavan
Familial dysautonomia
Gaucher’s
Nieman-Pick
Maple syrup urine
Prenatal screening for which ethnic group?
A
Ashkenazi Jews
6
Q
Hemoglobin E/beta thalassemia disease
Which ethnic group Prenatal Screening
A
Southeast Asian
7
Q
Underweight
Normal
Over
Obese
How much weight in 2nd and 3rd tri should each category gain?
How much weight should each category gain per week
A
Underweight 28 - 40
Normal 25 - 35
Over 15 - 25
Obese 11 - 20
Underweight 1
Normal 1
Over 0.6
Obese 0.5
8
Q
Fertile window starts ___ days prior to ovulation and ends on the day of ovulation - (egg is released from an ovary and into the fallopian tube during a woman’s menstrual cycle)
A
5 days prior to ovulation
9
Q
Assume 28 day cycle
Which day is ovulation?
Which days are Fertile?
A
Ovulation day 14
Fertile around day 9
10
Q
Early preggers HCG Human Chorionic Gonadotropin is produced by the trophoblastic cells surrounding the embryo
HCG doubles every 48 - 72 hrs.
<6,000 hcg levels increase by atleast ___ % every 2-3 days
Hcg levels that don’t rise properly can lead to….
A
60
Miscarriage
11
Q
Pregnancy test measure Hcg and are 97% accurate
How quickly?
A
1 week after fertilization
12
Q
Signs felt by early preggers
A
Thirsty
Vivid dreams
Missed period
Increase sense of smell
FOOD AVERSIONS
Sad
Breast change
Increase urination
Cramps
Nausea
Fatigue
Increase Body Temp
13
Q
Objective signs of preggers
Compressibility and softening of cervical isthmus. (Portion of cervix between uterus & vaginal portion of cervix)
A
Hegar sign
14
Q
Hegar
A
Objective signs of preggers
Compressibility and softening of cervical isthmus. (Portion of cervix between uterus & vaginal portion of cervix)
15
Q
Goodwill Sign
A
Softening of vaginal portion of cervix from increased vascularity
16
Q
Normal RR in preggers
HR
What happens with BP
Cardiac output?
A
12 - 24
Up to 110
Lower BP
Cardiac output Doubles
17
Q
Are varicose & spider veins expected during preggers
How about dizzy / fainting
A
Yeppers
They happen
18
Q
Softening of cartilage caused by ______ allows for Body to adapt to growing baby and gives woman a Pregnancy Waddle
A
Rise progesterone
19
Q
Ligament that connects Uterus to Labia Majora ……
Pain in the area gets worse each pregnancies BURNING CRAMP
A
Round ligament pain
20
Q
Increase or Decrease
WBC
Clotting factors
Plasma
A
WBC UP
Clotting factors UP
Plasma UP - Result Dilution Anemia- RBC Stays the same and plasma volume increases
21
Q
Values
Non preggers
Hemoglobin 13.3
Hemocrit 38 - 45
WBC 4 - 11
Fibrinogen 300
Platelets 140 - 440
A
Hemoglobin 11
Hemocrit 32 - 34
WBC 6 - 14
Fibrinogen 450
Platelets 150 - 400
22
Q
Chloasma ….
A
Mask of preggers
Due to increased Perfusion & Vascularness to skin (Releases Heat)
23
Q
Linea Nigra….
A
Hypermelanosis up the abdomen
24
Q
Why Hydronephrosis (excess fluid in a kidney due to a backup of urine)
in 90-95% of women?
A
Increased Perfusion to kidneys
Increase GFR/ Urine output
Ureter compression from the uterus
25
Stress incontence happens from...
Decreased bladder tone
26
Describe Gastrointestinal Adaptation
Decreases smooth muscle relaxation / Decreased Peristalsis
Increased
N/V
Heartburn
Constipation
Hemorroides
Gallstones
27
______ increases prolactin
Thyroid, increases thyroxine increases _____
Parathyroid does...
Ovaries / Placenta...
Pituitary Gland
Basal metabolic rate
Increases PTH for increased calcium & phosphorus
Increases Estrogen, Progesterone, Relaxin
28
Fundus height continues to rise until ...
Reasons for a higher fundal height?
Lower?
Typically which week does it stop growing
Fetus engages in Pelvis prior to delivery
High fundal height = Multiple babies, big baby, Molar Preggers (tumor that develops in the uterus as a result of a nonviable pregnancy)
Lower: IUGR Intrauterine growth restriction, SGA, Fetal demise
36th week
29
Fundal height between 20th - 36th week
Matches number of weeks
30
A variation of ___cm could suggest an issue with fetal dev
2cm
31
Are painful breast and nipples ever normal in preggers
Yes esp in 1st trimester
32
Psychological Adpation
1st
2nd
3rd
1st Ambivalent/ Focuses on herself
2nd ID with mother role, Reorder personal relationships
3rd: Prepare for birth, fantasy about baby, Nesting
33
1st trimester
Week 1 - 4
Weeks 3 - 8
Week 5 - 8
9 - 12
Week 1 - 4
Implantation
3rd week primitive heart beat
Weeks 3 - 8
All major organs formed
Week 5 - 8
Heart begins to pump
Arms & legs bud
Facial features begin to form
9 - 12
Extremities developed
External Genital differentiate
34
Weeks most susceptible to Teratogens
3 - 8
35
2nd Trimester
13 - 16
17 - 20
21 - 24
25 - 28
13 - 16
Fetus begins to move
Urine formation begins
17 - 20
Meconium begins collecting in bowels
21 - 24
Skin wrinkled, red, vernix, lanugo
25 - 28
Eyes partially opened
Resp. System still immature
36
3rd trimester
29 - 32
33 - 36
37 - 40
29 - 32
Toe nails & testies descended
33 - 36
Skin thicker, Fat accumulation, Excelente chance of survival
37 - 40
Baby gains fat
Nails extend beyond nail bed
37
Wharton's Jelly
Gelatinous mucosal tissue that cushions and insulated the umbilical cord vessels
38
Umbilical cord shunts Deoxygenated blood where
Placenta
39
3 structures shunt blood away...
Ductus arteriosus
Foramen Ovale
Ductus venosus
40
Prenatal care
1st trimester: First Visit to confirm pregnancy? May include US
2ND: Follow up every ___ weeks.
US scheduled at ____ weeks.
3rd: Follow up visit every 2 weeks once mom is ____ weeks pregnant.
After ____ weeks it is weekly visit
1st: between 8 - 10 weeks
2nd: Follow up every 4 weeks past initial visit. Anatomy US is scheduled between 18 - 20 weeks.
3rd: Follow up visit every 2 weeks once 28 weeks. After 36 weeks it's weekly visit
41
First trimester: Weeks _____
Second trimester: Weeks _____
Third trimester: Weeks _____
First trimester: Weeks 1–12
Second trimester: Weeks 13–26
Third trimester: Weeks 27–40
42
1st visit
What happens
Prenatal panel
Pelvic exam
Confirm pregnancy
H&P
Abuse screening
STI
43
STI
Often no symptoms
Cervical culture
Blood test, VDRL, RPR
Molecular testing or Wet prep slide of vaginal discharge
OK
44
How to lower risk of giving HVI to new born
Antivirals during preggers
C/S
No breastfeeding
45
State Naegales rule...
Based on 28 day cycle
Subtract 3 months from 1st day of previous Menstrual Period & Add 7 days
46
Caloric increase needed by trimester
1st None
2nd 340/day
3rd 450/day
47
Foods to avoid
Shark,swordfish, king mackerel, tile fish.
Lunch meat / hotdogs unless steaming hot
Soft cheese unless made with pasteurized milk
Pate, meat spread, smoked seafood
Unpasteurized milk, dairy, cider
Max 12 oz shrimp, salmon, pollock, catfish, and canned tuna per week
48
Iron
Standard dose....
Special case dose...
Tips...
30mg Ferrous Sulfate 2nd & 3rd Tri
If anemic take 60 - 120mg
Cannot be supplied completely by diet
Take on empty stomach
Take with OJ to help absorption
Don't Take with calcium supplements, milk, tea, coffee decreases absorption
49
Foods that contain iron
Meats, green leafy veg, eggs, grain, enriched products, dried fruits, tofu, legumes, nuts
50
Preggers is an immunosuppressed state
True or False
True
51
Which vaccines are safe to get when preggers...
Which are strong NO
Covid, Flu, Tdap
HPV, MMR, VARICELLA, ZOSTER
Others are maybe
52
Fetal Testing
Ultrasound
Type of test (Screening/ Diagnostic)
How it works?
Preformed when?
Screening
Visible build up of fluid on neck maybe sign of a disorder
11 - 14 weeks
53
Amniocentesis
Screening or Diagnostic test
What does...
Needle through belly extracts amniotic fluid
Performed at....
Diagnostic
ID chromosomal abnormalities, inherited, and spinal column / brain defects
Performed at 15 - 20 weeks
54
Chorionic Villus Sampling CVS
Screening or Diagnostic
How is it performed?
What it does.....
Performed at....
Risks....
Diagnostic
Tissue from the placenta check for genetic or chromosomal abnormalities in a fetus.
ID chromosomal & inherited diseases
Performed 10 - 12 weeks
Risk miscarriage 1 out of 500. Bigger risk than amniocentesis 1 out of 1,000
55
Maternal blood test.
Also allows for chromosomal abnormalities screening
Maternal blood contains fetal DNA which passes through the placenta
Performed at....
Detects 99% of Downs - up to 50% of positives are false
10 weeks or later
56
Fetal test...
NIPT : Innatal, Maternity21
blood test that analyzes fetal DNA in the mother’s blood to screen for chromosomal abnormalities such as Down syndrome (trisomy 21), trisomy 18, and trisomy 13.
Purpose: It’s non-invasive and provides early risk assessment for genetic conditions, typically performed as early as 10 weeks into pregnancy.
Maternal Serum AFP
level of alpha-fetoprotein, a protein produced by the fetal liver, in the mother’s blood.
Purpose: High or low levels may indicate neural tube defects (like spina bifida), abdominal wall defects, or chromosomal abnormalities. It’s usually part of the second-trimester quad screen.
CVS
placental tissue (chorionic villi) is removed for testing.
Purpose: 10-13 weeks
Detect chromosomal or genetic disorders, such as cystic fibrosis or Down syndrome.
Amniocentesis
15-20 weeks to diagnose chromosomal abnormalities, neural tube defects, and genetic conditions.
fetal lung maturity in later pregnancy if preterm delivery is being considered.
BPP Biophysical profile
five factors—fetal heart rate, breathing movements, body movements, muscle tone, and amniotic fluid level
3rd trimester
NST
monitors the fetal heart rate in response to fetal movements using external monitoring
3rd trimester
57
Why are the first & second ultrasound performed
1st Confirm IUP Intrauterine pregnancy
2nd Anatomy Scan
58
GTT
Fasting 1 hr and possibly 3 hr repeat test for gestational diabetes in ___ trimester
2nd
59
Blood test
CBC
T&S
Rubella
HIV
VDRL/RPR
Hep B
HSV 1&2
60
GBS Culture when
What if positive
35 - 37 weeks / vag & rectum
If positive mom recieves PCN while in active labor Q4H until delivery
First dose 5 million units & additional dose 2.5 million units
61
Why call a provider if patient has
Headache not helped by tylenol
Visual disturbances
SOB & RUQ pain
Preeclampsia
62
Prenatal panel (10)
Blood Type and Rh Factor: Determines the mother’s blood type (A, B, AB, or O) and Rh status (positive or negative) to assess the risk of Rh incompatibility with the fetus.
Complete Blood Count (CBC): Measures hemoglobin, hematocrit, and red and white blood cell counts to check for anemia, infections, and overall blood health.
Rubella Immunity: Tests for immunity to rubella (German measles), as a rubella infection during pregnancy can cause birth defects.
Hepatitis B and C Screening: Checks for hepatitis B and C infections that could affect the fetus.
HIV Screening: Screens for HIV, as early treatment can reduce the risk of mother-to-child transmission.
Syphilis Screening: Tests for syphilis, which can be treated during pregnancy if detected early.
Varicella Immunity: Tests for immunity to chickenpox, which can cause complications if contracted during pregnancy.
Urine Culture: Checks for urinary tract infections (UTIs), protein, glucose, or ketones, which could indicate gestational diabetes or other concerns.
Cystic Fibrosis Screening: Offers genetic testing to see if the mother is a carrier of cystic fibrosis.
Thyroid Function Tests: Checks thyroid hormone levels, as thyroid dy
63
Taylor Sachs disease
Describe
Degenerative neurological
Die young
64
Obese women usually (Gain or Lose) weight during preggers
Lose
65
How long can sperm live in women's reproductive tract
Up to five days
66
Chemical pregnancy...
Pregant according to the Pee preggers test but the baby doesn't survive.
No implementation
hcg increases but no baby comes
human chorionic gonadotropin (hCG) level of 25 mIU/mL or higher typically indicates pregnancy.
67
N/V starts when in preggers
6 weeks
68
Probable preggers signs (4)
Hegars
Goodwill
Chadwick (Bluish cervix, vagina, vulva)
Positive Hcg test
69
Due to ____ there is a change in the center of gravity in a preggers, causing falls.
Falls are more likely to result in injury due to____
Both
Softening of cartilage
70
Hemoglobin is decreased bc of increased plasma (dilation of RBC concentration) which number would be a concern and what is the remedy
10 or below
Iron
71
Fundus before preggers is found where
Pubis symphysis
72
Meaure uterus from these landmarks
Uterus size and gestational age correlation
Top of pubic bone / Fundus
Size will be the same as length in cm
73
Montgomery glands do what?
Lubricate the nipple
74
Milky discharge may start as early as...
15 weeks
75
When does the primitive heart begin to beat....
When does the babies heart begin to pump....
1 - 4
5 - 8
76
When does quickening happen?
13 - 16 weeks
77
By ___ weeks the baby has a good chance for survival if it is a normal weight
22 - 24
More likely 24
>500 g
78
AFI normal range
Probably more correct than other card
8 - 25
79
Oligohydramnios
Maybe a problem with this organ in the baby
Kidneys
They are taking amniotic fluid in but not peeing it out
80
Excessive amniotic fluid >25 AFI
Maybe this problem with the mom
DM
81
Facilitates nutrient, oxygen, waste exchange between mother and fetus
Placenta
82
Is there contact between mother and baby's blood?
No, there is diffusion of nutrients
83
Conditions that damage blood vessels also damage the placenta.
Give 2 examplez
HTN & DM
84
Placental insufficiency can cause IUGR
T OR F
T
Insufficient Uterine Growth Restriction
85
Fetal circulation
Vein carry oxygenation blood & Arteries carry Deoxygenated blood
T or f
T
86
Study fetal blood circulation videos
Fetal Shunts on power point
On test
87
The three fetal shunts are specialized structures that allow blood to bypass certain areas in the developing fetal circulation, optimizing oxygen delivery and nutrient flow before birth.
These shunts are crucial because the fetal ____ & ____ are not fully functional until after birth
lungs and liver
88
__________
Location: Connects the umbilical vein directly to the inferior vena cava.
Function: Allows oxygenated blood from the placenta to bypass the fetal liver and flow directly into the fetal heart, ensuring the oxygen-rich blood reaches vital organs faster.
Closure After Birth: Closes shortly after birth, becoming the ligamentum venosum in the liver.
Ductus Venosus
89
Ductus Venosus
Location:
Function:
Closure After Birth:
Location: Connects the umbilical vein directly to the inferior vena cava.
Function: Allows oxygenated blood from the placenta to bypass the fetal liver and flow directly into the fetal heart, ensuring the oxygen-rich blood reaches vital organs faster.
Closure After Birth: Closes shortly after birth, becoming the ligamentum venosum in the liver.
90
_____
Location: An opening between the right and left atria in the fetal heart.
Function: Allows oxygenated blood to flow directly from the right atrium to the left atrium, bypassing the non-functioning fetal lungs, which are still filled with fluid.
Closure After Birth: Usually closes within the first few days or weeks after birth due to changes in pressure, forming the fossa ovalis.
Foramen Ovale
Location: An opening between the right and left atria in the fetal heart.
Function: Allows oxygenated blood to flow directly from the right atrium to the left atrium, bypassing the non-functioning fetal lungs, which are still filled with fluid.
Closure After Birth: Usually closes within the first few days or weeks after birth due to changes in pressure, forming the fossa ovalis.
91
Foramen Ovale
Location:
Function:
Closure After Birth:
Foramen Ovale
Location: An opening between the right and left atria in the fetal heart.
Function: Allows oxygenated blood to flow directly from the right atrium to the left atrium, bypassing the non-functioning fetal lungs, which are still filled with fluid.
Closure After Birth: Usually closes within the first few days or weeks after birth due to changes in pressure, forming the fossa ovalis.
92
_________
Location: Connects the pulmonary artery to the aorta.
Function: Diverts most of the blood away from the lungs and into the aorta, as the fetal lungs are not yet used for oxygen exchange.
Closure After Birth: Begins to close within hours after birth due to increased oxygen levels, eventually forming the ligamentum arteriosum
Ductus Arteriosus
Location: Connects the pulmonary artery to the aorta.
Function: Diverts most of the blood away from the lungs and into the aorta, as the fetal lungs are not yet used for oxygen exchange.
Closure After Birth: Begins to close within hours after birth due to increased oxygen levels, eventually forming the ligamentum arteriosum
93
Ductus Arteriosus
Location:
Function:
Closure After Birth:
Ductus Arteriosus
Location: Connects the pulmonary artery to the aorta.
Function: Diverts most of the blood away from the lungs and into the aorta, as the fetal lungs are not yet used for oxygen exchange.
Closure After Birth: Begins to close within hours after birth due to increased oxygen levels, eventually forming the ligamentum arteriosum
94
Pregnancy test
CBC
Prenatal panel
Dating ultrasound
Maternal blood serum
Nuchal translucency (NT) is ....
a prenatal screening ultrasound measurement that assesses the fluid-filled space at the back of a fetus's neck.
Checks for chromosomal abnormalities and heart defects
95
Cell free DNA
Chorionic Villus Sampling
Are non routine test preformed when...
1st trimester
Cell free DNA
non-invasive prenatal screening (NIPS) test that analyzes small fragments of fetal DNA circulating in the mother’s blood. This test can detect chromosomal abnormalities.
Purpose: Screens for condition NOT diagnosis
CVS
An invasive diagnostic test where a small sample of cells (chorionic villi) is taken from the placenta and analyzed for genetic abnormalities.
Purpose: Diagnoses chromosomal abnormalities and genetic disorders, including Down syndrome, cystic fibrosis, and certain inherited conditions. CVS
96
Glucose challenge test if fail....
Glucose tolerance test
Must be in fasting state for GTT
Several measurements of BS are taken at 1, 2 , 3 hrs
97
Redo PP Prental test
Be more specific
98
Baby kick test
What is normal
>10 per hour
99
Biggest cause of death to preggers women
Homicide
100
Tdap vaccine is given during this trimester.
Which disease is the concern
3rd
Pertussis (Whooping Cough)
101
This diagnostic test ____ is used to determine fetal lung development in 3rd trimester
Amniocentesis
102
Advantage of Amniocentesis over Chorionic Villus Sampling
Can detect neural tube defects (Spina bifida) CVS cant
103
Screening test done mostly on moms who are DM or placental deteriorating.
5 category test
Fetal movements
Fetal tone
Fetal breathing movements
Amniotic fluid volume
Non-stress test
Less than 10 depending on GA recommended delivery, possibly
Biophysical profile
104
AFP
Maternal Serum Alpha fetoprotein test
High levels might indicate....
Neuraltube defects #1 thing AFP is screening for
105
GBS can cause these problems in babies
Meningitis / pneumonia
106
With fetal tachycardia do this assessment on the mom
Temp.
Infection
107
Palpation of fundus with toco
Describe firmness of mild, moderate, hard
Mild Nose
Moderate chin
Hard forehead
108
To ensure your tracing baby's not moms HR apply....
OX meter on mom
109
IUPC goes where..
Between uterine wall and baby's head
110
Good acid base balance, best predictor of fetal oxygenation is....
Moderate Variability 6-25 BMP change
111
2 causes of minimal variability
Sleeping baby / Drugs
112
Connects pulmonary artery & descending aorta
Causes blood flow to bypass the Non-functioning Lungs
Closes by first breaths & increased pressure in aorta within 15 - 24 hrs of birth.
MURMURS maybe heard until closed
Ductus Arteriosus
113
Flap between Right and left atria
Closes when left atria faces increase pressure after birth
Closed within minutes of birth
Foramen Ovale
114
Directs blood from Umbilicus vein away from liver to inferior vena cava
Once Umbilicus cord is clamped little blood enters..
Ductus Venosus
115
Routine prenatal testing & Nonroutine
1st trimester
Pregnancy test
Blood test CBC / T/S
Urine test
US placement/ dating
NonRoutine
Cell free DNA
Chorionic Villus Sampling
116
Prenatal testing 2nd trimester
Routine & nonroutine
Routine
Urine fetal hr
Glucose challenge test - if failure GTT
Quad screen
Anatomical US
NonRoutine
GTT
Amniocentesis
117
Routine & nonroutine prenatal testing
3rd trimester
Urine
FHR
Group B strep Swab vag & anus
Kick count >10 norm
NonRoutine
US
Nonstress test
Contraction stress test
Biophysical profile
118
Give Rho-gam when (2)
Why not give Rho-gam
28 weeks & within 72 after birth
Positive blood type mom don't need Rho-gam.
119
How to test for
Gonorrhea
Syphilis
Trichomonas
Gonorrhea: Cervical Culture
Syphilis: Blood test (VDRL/RPR)
Trichomonas: Molecular test/ Wet prep slides Vag discharge
120
Anemia due to blood dilution in ___ semester.
Take 400 micrograms Iron daily
2nd
121
Describe
Nonstress test
Contraction stress test
Biophysical profile
NST
monitor on abdomen to measure the fetal heart rate and uterine contractions.
Goal see how the fetal heart rate responds to fetal movements without the stress of contractions.
Interpretation:
A "reactive" result is ideal, indicating that the fetal heart rate accelerates appropriately with movements.
A "nonreactive" result may require further testing to check on the baby’s health.
Contraction stress test
Mild contractions are stimulated, either by nipple stimulation or low-dose oxytocin (Pitocin), while monitoring the fetal heart rate response.
The aim is to check if the fetus remains stable when uterine contractions temporarily reduce oxygen delivery.
Interpretation:
A "negative" CST is preferred and means that there are no concerning drops in fetal heart rate during contractions, indicating the baby can likely handle labor. A "positive" CST, which shows late decelerations of fetal heart rate with contractions.
Biophysical profile
ultrasound with a nonstress test. It’s often used when there’s a need for a more thorough evaluation of fetal well-being.
Process: The BPP includes five components:
Fetal heart rate reactivity (from NST)
Fetal breathing movements
Fetal movement
Fetal muscle tone
Amniotic fluid volume Each component is given a score of 0 (absent) or 2 (present), with a maximum score of 10.
Interpre
A score of 8-10 is considered normal
A lower score (e.g., 4 or less) may indicate fetal distress or other concerns, potentially leading to closer monitoring or consideration of delivery, depending on the gestational age and clinical context.
122
Down syndrome (Trisomy 21):
Typically, this is associated with ( low / high) hCG and Inhibin-A levels and (low / high) AFP and estriol levels.
Trisomy 18 (Edwards syndrome): Usually associated with (low / high )levels of all four substances (AFP, hCG, estriol, and Inhibin-A).
Neural tube defects (like spina bifida): These may be indicated by (low / high )AFP levels, as AFP can leak into the amniotic fluid and cross into the mother’s bloodstream if the neural tube is not fully closed.
Down syndrome (Trisomy 21): Typically, this is associated with high hCG and Inhibin-A levels and low AFP and estriol levels.
Trisomy 18 (Edwards syndrome): Usually associated with low levels of all four substances (AFP, hCG, estriol, and Inhibin-A).
Neural tube defects (like spina bifida): These may be indicated by higher-than-normal AFP levels, as AFP can leak into the amniotic fluid and cross into the mother’s bloodstream if the neural tube is not fully closed.
123
When to call DR. as a preggers woman (8)
Severe ab cramps/ pain
Bleeding/ spotting
Persistent headaches not relieved by meds
Blurry vision/ Swelling
Decreased fetal movement (Quickening happens around weeks 13 - 16)
Fluid leakage
Signs of infection
Contractions before 37 weeks
