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Questions and Answers
What does 'A' represent in the GTPAL system?
What does 'A' represent in the GTPAL system?
Which term refers to a woman who has not had a birth past 20 weeks of gestation?
Which term refers to a woman who has not had a birth past 20 weeks of gestation?
In the provided example, what is the parity number of the woman who is pregnant for the fourth time?
In the provided example, what is the parity number of the woman who is pregnant for the fourth time?
What does the 'P' in the GTPAL abbreviation signify?
What does the 'P' in the GTPAL abbreviation signify?
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How many living children does the woman in the example have?
How many living children does the woman in the example have?
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What is the estimated duration of a normal pregnancy, measured in days?
What is the estimated duration of a normal pregnancy, measured in days?
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Using Nägele’s rule, if the first day of the last menstrual period is September 12, 2014, what would be the estimated date of confinement?
Using Nägele’s rule, if the first day of the last menstrual period is September 12, 2014, what would be the estimated date of confinement?
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What term describes a woman who has never been pregnant?
What term describes a woman who has never been pregnant?
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During the antepartum period, care primarily focuses on which of the following?
During the antepartum period, care primarily focuses on which of the following?
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Which measurement method does McDonald’s rule utilize to determine pregnancy duration?
Which measurement method does McDonald’s rule utilize to determine pregnancy duration?
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What is meant by the term 'gravidity'?
What is meant by the term 'gravidity'?
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What does a primigravida signify in obstetric terminology?
What does a primigravida signify in obstetric terminology?
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Which of the following is NOT a focus area of nursing care during the antepartum period?
Which of the following is NOT a focus area of nursing care during the antepartum period?
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At what week do ducts and glands in the breasts begin to develop?
At what week do ducts and glands in the breasts begin to develop?
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What changes are observed in the areola during weeks 8 to 12 of pregnancy?
What changes are observed in the areola during weeks 8 to 12 of pregnancy?
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What is 'striae gravidarum' commonly known as?
What is 'striae gravidarum' commonly known as?
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Vascular spider nevi can develop as a result of increased levels of which hormone?
Vascular spider nevi can develop as a result of increased levels of which hormone?
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What psychological change might a mother experience early in pregnancy?
What psychological change might a mother experience early in pregnancy?
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Which area is NOT typically affected by increased pigmentation during pregnancy?
Which area is NOT typically affected by increased pigmentation during pregnancy?
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What effect does increased progesterone have on posture during pregnancy?
What effect does increased progesterone have on posture during pregnancy?
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Which of the following best describes the effect of pregnancy on maternal immunity?
Which of the following best describes the effect of pregnancy on maternal immunity?
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Which of the following is considered a presumptive sign of pregnancy?
Which of the following is considered a presumptive sign of pregnancy?
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What does Hegar's sign indicate during pregnancy?
What does Hegar's sign indicate during pregnancy?
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Which test is used to screen for cervical neoplasia during the initial prenatal examination?
Which test is used to screen for cervical neoplasia during the initial prenatal examination?
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What is quickening in the context of pregnancy?
What is quickening in the context of pregnancy?
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Which sign is characterized by the softening of the cervix during early pregnancy?
Which sign is characterized by the softening of the cervix during early pregnancy?
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What does Chadwick’s sign reveal about a pregnant woman?
What does Chadwick’s sign reveal about a pregnant woman?
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Which of the following tests checks for the presence of rubella antibodies?
Which of the following tests checks for the presence of rubella antibodies?
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At what gestational age can fetal heart rate be detected using an electronic device?
At what gestational age can fetal heart rate be detected using an electronic device?
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During which trimesters is urinary urgency and frequency most likely to occur?
During which trimesters is urinary urgency and frequency most likely to occur?
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What is the primary cause of heartburn during pregnancy?
What is the primary cause of heartburn during pregnancy?
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Which intervention is not recommended for relieving backache during pregnancy?
Which intervention is not recommended for relieving backache during pregnancy?
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What is one of the recommended interventions for managing shortness of breath in pregnant women?
What is one of the recommended interventions for managing shortness of breath in pregnant women?
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What is the primary intervention for managing leg cramps during pregnancy?
What is the primary intervention for managing leg cramps during pregnancy?
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Which dietary change is suggested to help relieve constipation during pregnancy?
Which dietary change is suggested to help relieve constipation during pregnancy?
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What is the effect of increased progesterone on gastrointestinal function during pregnancy?
What is the effect of increased progesterone on gastrointestinal function during pregnancy?
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Which of the following practices is recommended for managing heartburn in pregnant women?
Which of the following practices is recommended for managing heartburn in pregnant women?
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Study Notes
Antepartum Period
- The antepartum period extends from conception to the onset of labor.
- During this time, the focus is on maternal and fetal health maintenance, as well as preventing complications.
- Nursing care during this period includes taking a thorough maternal history, performing a complete physical examination, and educating the client about antepartum health.
Obstetrical History/ Assessment
- Gestation: Refers to the time from fertilization of the ovum until the estimated date of confinement or estimated date of delivery. This typically lasts about 280 days.
- Nägele’s rule is commonly used to estimate the date of confinement. It requires a regular 28-day menstrual cycle and involves subtracting 3 months and adding 7 days to the first day of the last menstrual period, then adding 1 year.
- McDonald’s rules utilize fundal height to determine the duration of pregnancy.
Gravidity and Parity
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Gravidity: Refers to a pregnant woman and the number of pregnancies she has had.
- A nulligravida has never been pregnant.
- A primigravida is pregnant for the first time.
- A multigravida is in at least her second pregnancy.
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Parity: Refers to the number of births carried past 20 weeks' gestation, regardless of whether the fetus was born alive.
- A nullipara has not had a birth before 20 weeks of gestation.
- A primipara has had one birth after 20 weeks of gestation.
- A multipara has had two or more pregnancies to the stage of fetal viability.
Obstetrical History: GTPAL System
- Many hospitals utilize the GTPAL or GTPALM system to record previous pregnancies.
- G: Number of pregnancies (gravida).
- T: Number of term infants born (longer than 37 weeks’ gestation).
- P: Number of preterm infants born (before 37 weeks’ gestation).
- A: Number of pregnancies ending in spontaneous or elective abortion (before 20 weeks).
- L: Number of living children.
- M: Total number of multiple pregnancies.
Signs and Symptoms of Pregnancy
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Presumptive Signs: These are subjective signs that can be caused by other factors, but are typical of pregnancy.
- Amenorrhea or slight, painless spotting in early gestation.
- Breast enlargement and tenderness.
- Fatigue.
- Increased skin pigmentation.
- Nausea and vomiting.
- Quickening: First recognizable movement of the fetus.
- Linea nigra: Dark line pigment on the abdomen.
- Chloasma: Pigmentary skin change on the face.
- Striae gravidarum: Red streaks on the abdomen.
- Urinary frequency and urgency.
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Probable Signs: These are objective signs that are more specific for pregnancy.
- Uterine enlargement.
- Hegar's sign: Compressibility and softening of the lower uterine segment (around week 6).
- Goodell's sign: Softening of the cervix (beginning of the second month).
- Chadwick's sign: Violet coloration of the mucous membranes of the cervix, vagina, and vulva (around week 4).
- Ballottement: Rebounding of the fetus against the examiner's fingers on palpation.
- Braxton Hicks contractions: Irregular, painless contractions that may occur intermittently throughout pregnancy.
- Positive pregnancy test for human chorionic gonadotropin (hCG).
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Positive Signs: These are definitive signs of pregnancy only caused by the fetus.
- Fetal heart rate detected by electronic device (Doppler transducer) at 10 to 12 weeks, and by a nonelectronic device (fetoscope) at 20 weeks.
- Active fetal movement felt by a trained provider after about 20 weeks.
- Ultrasound showing fetal outline.
Antepartum Diagnostic Testing
- Blood Type, Rh, and Abnormal Antibodies: Identify whether the fetus is at risk for erythroblastosis fetalis or hyperbilirubinemia.
- Immunologic Tests: Detect the presence of rubella, syphilis, and hepatitis B.
- Papanicolaou's Smear: Screen for cervical neoplasia.
System Specific Changes
Breast Changes
- 6 Weeks: Development of ducts and glands.
- 8 Weeks: Bluish surface veins are visible. Breasts are tense, warm, tender, enlarged with dilated veins and darkened primary areola.
- 8-12 Weeks: Primary areola become darker, secondary areola emerge.
- 16-18 Weeks: Colostrum is secreted, secondary areola appears.
Dermatological System
- Increased Skin Pigmentation: Occurring in areas like areola, nipples, vulva, and perianal area.
- Linea Nigra: Pigmentation or darkness in the linea alba.
- Facial Chloasma: Irregular pigmentation of the cheeks, forehead, and nose, accentuated by sun exposure.
- Striae Gravidarum (Stretch Marks): Appear on the breasts and abdomen due to increased weakness of connective tissue.
- Vascular Spider Nevi: Small, bright-red elevations of the skin with radiating branches. Develop on the chest, neck, face, arms, and legs, caused by increased blood flow due to estrogen levels.
Musculoskeletal System
- Postural Changes: Lordosis (waddling gait), due to increased progesterone and relaxation hormones, counterbalances the effect of the protruding abdomen.
- Low Backache: Increased curving in the spine can result in low backache.
Metabolic Changes
- Increased Metabolic Rate: Higher demand for carbohydrates, protein, and minerals.
- Increased Water Requirement: Supply for the fetus, placenta, and amniotic fluid.
Immunological System
- Decreased Resistance to Infection: Maternal IgG levels decrease, making mothers more susceptible to infection.
Maternal Psychological Changes
- Ambivalence: Experienced early in pregnancy (even when planned) due to dependence-independence conflict and role changes. Fathers may also experience ambivalence related to their changing roles, financial responsibilities, and sharing attention with the partner.
Common Discomforts of Pregnancy
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Urinary Urgency and Frequency: Occurs in the first and third trimesters due to pressure of the uterus on the bladder.
- Interventions: Limiting fluid intake in the evening, voiding at regular intervals, sleeping side-lying, wearing perineal pads, and Kegel exercises.
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Heartburn: Occurs in the second and third trimesters due to increased progesterone levels, decreased gastrointestinal motility, esophageal reflux, and displacement of the stomach.
- Interventions: Eating small, frequent meals, sitting upright after eating, drinking milk between meals, avoiding fatty and spicy foods, consulting with a healthcare provider about antacids.
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Backache: Occurs in the second and third trimesters due to an exaggerated lumbosacral curve caused by the enlarged uterus.
- Interventions: Obtaining adequate rest, using correct posture & body mechanics, wearing low-heeled, comfortable, supportive shoes, sleeping on a firm mattress.
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Shortness of Breath: Can occur in the second and third trimesters due to pressure on the diaphragm from the enlarged uterus.
- Interventions: Taking frequent rest periods, sitting and sleeping with the head elevated or on the side, avoiding overexertion.
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Leg Cramps: Usually occur in the second and third trimesters due to altered calcium-phosphorus balance, pressure of the uterus on nerves, or fatigue.
- Interventions: Getting regular exercise (especially walking), dorsiflexing the foot of the affected leg.
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Constipation: Occurs in the second and third trimesters due to increased progesterone production, decreased intestinal motility, displacement of the intestines, pressure of the uterus, and iron supplements.
- Interventions: Eating high-fiber foods, drinking plenty of water (2000 mL per day).
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Description
This quiz covers essential concepts related to the antepartum period, including maternal and fetal health maintenance and nursing care. It also explores obstetrical history, gestation, and the application of Nägele’s and McDonald’s rules. Test your knowledge and understanding of these key aspects of prenatal care.
