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Questions and Answers
Which fetal assessment score indicates a need for immediate delivery?
Which fetal assessment score indicates a need for immediate delivery?
What is a presumptive sign of pregnancy that can occur around 18 to 20 weeks in primigravida?
What is a presumptive sign of pregnancy that can occur around 18 to 20 weeks in primigravida?
Which of the following symptoms is commonly associated with the first trimester of pregnancy?
Which of the following symptoms is commonly associated with the first trimester of pregnancy?
What is the primary hormone detected in urine pregnancy tests?
What is the primary hormone detected in urine pregnancy tests?
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What describes the probable sign of pregnancy where a dark line appears on the abdomen?
What describes the probable sign of pregnancy where a dark line appears on the abdomen?
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At what gestational age can cardiac movement of the fetus typically be observed sonographically?
At what gestational age can cardiac movement of the fetus typically be observed sonographically?
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What laboratory test method can detect hCG levels before a missed period?
What laboratory test method can detect hCG levels before a missed period?
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Which of the following is not categorized as a positive sign of pregnancy?
Which of the following is not categorized as a positive sign of pregnancy?
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What physiological change contributes to the protective barrier in pregnancy?
What physiological change contributes to the protective barrier in pregnancy?
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Which of the following hormonal effects is related to the smooth muscle relaxation in pregnancy?
Which of the following hormonal effects is related to the smooth muscle relaxation in pregnancy?
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What is a potential cause of edema in pregnant individuals?
What is a potential cause of edema in pregnant individuals?
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Which condition is related to increased levels of estrogen, progesterone, and prostaglandins?
Which condition is related to increased levels of estrogen, progesterone, and prostaglandins?
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During pregnancy, what change occurs in laboratory values due to adaptations in the cardiovascular system?
During pregnancy, what change occurs in laboratory values due to adaptations in the cardiovascular system?
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What method can help relieve edema in the lower extremities for pregnant individuals?
What method can help relieve edema in the lower extremities for pregnant individuals?
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What approach is used for monitoring daily fetal movement counts after 28 weeks gestation?
What approach is used for monitoring daily fetal movement counts after 28 weeks gestation?
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Which physiological adaptation causes the increased likelihood of urinary tract infections during pregnancy?
Which physiological adaptation causes the increased likelihood of urinary tract infections during pregnancy?
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What defines a positive result in a Contraction Stress Test?
What defines a positive result in a Contraction Stress Test?
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Which of the following statements about the Amniotic Fluid Index (AFI) is true?
Which of the following statements about the Amniotic Fluid Index (AFI) is true?
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What characterizes a reactive Nonstress Test (NST)?
What characterizes a reactive Nonstress Test (NST)?
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What does oligohydramnios indicate in terms of the Amniotic Fluid Index?
What does oligohydramnios indicate in terms of the Amniotic Fluid Index?
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What defines the normal range for Amniotic Fluid Index (AFI)?
What defines the normal range for Amniotic Fluid Index (AFI)?
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What is the goal of a biophysical profile?
What is the goal of a biophysical profile?
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Why is the Contraction Stress Test associated with a high false positive rate?
Why is the Contraction Stress Test associated with a high false positive rate?
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What is a primary characteristic of a screening test?
What is a primary characteristic of a screening test?
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What role does the trophoblast play in the development of the placenta?
What role does the trophoblast play in the development of the placenta?
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Which statement accurately describes the foramen ovale?
Which statement accurately describes the foramen ovale?
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What is the primary role of ductus arteriosus in fetal circulation?
What is the primary role of ductus arteriosus in fetal circulation?
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Which of the following correctly describes the formation of the placenta?
Which of the following correctly describes the formation of the placenta?
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Which hormone primarily stimulates the production of progesterone during early pregnancy?
Which hormone primarily stimulates the production of progesterone during early pregnancy?
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What is a function of the chorionic villi in the placenta?
What is a function of the chorionic villi in the placenta?
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After the umbilical cord is cut, what causes the ductus arteriosus to constrict?
After the umbilical cord is cut, what causes the ductus arteriosus to constrict?
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What is the main metabolic function of the placenta?
What is the main metabolic function of the placenta?
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What does GTPAL stand for in documenting obstetric history?
What does GTPAL stand for in documenting obstetric history?
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In which trimesters should a woman be educated about signs of labor?
In which trimesters should a woman be educated about signs of labor?
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What factors are assessed during the initial prenatal visit?
What factors are assessed during the initial prenatal visit?
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Which of the following best defines teratogenesis?
Which of the following best defines teratogenesis?
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At what gestational age is screening for gestational diabetes typically performed?
At what gestational age is screening for gestational diabetes typically performed?
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Which screening is conducted between 35-37 weeks of gestation?
Which screening is conducted between 35-37 weeks of gestation?
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Which component is a part of comprehensive prenatal education during the third trimester?
Which component is a part of comprehensive prenatal education during the third trimester?
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What is the primary purpose of a urine culture and sensitivity test during pregnancy?
What is the primary purpose of a urine culture and sensitivity test during pregnancy?
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Study Notes
Physiologic Adaptations to Pregnancy
Uterine Changes
- Uterus undergoes hypertrophy of the uterine wall.
- Vaginal muscles and connective tissue soften, preparing for birth.
- Increased contractibility leads to Braxton-Hicks contractions.
- Cervical glands enlarge to form a mucus plug, acting as a protective barrier.
- Uterus expands and stretches to accommodate the growing fetus.
- Circulatory volume expands, causing vascular congestion.
- Abdominal muscles stretch, which may lead to diastasis recti.
- Increased vascularity in vaginal and cervical glands results in heightened leukorrhea.
- Amenorrhea, or absence of menstruation, occurs during pregnancy.
Hormonal Impact on Smooth Muscle
- Muscle relaxation is facilitated by respiratory estrogen, progesterone, and prostaglandins, potentially causing:
- Dyspnea and nasal congestion.
- Epistaxis (nosebleeds).
- Renal effects include increased urine output, incontinence, and a higher risk of urinary tract infections due to progesterone.
- Gastrointestinal changes result in bloating, flatulence, and constipation also linked to progesterone.
- Estrogen and progesterone relax smooth muscles in the cervix and pelvic floor ligaments.
Edema in Lower Extremities
- Edema is caused by increased venous pressure and compression of iliac veins and inferior vena cava during pregnancy.
- Decreased renal flow occurs, particularly in the third trimester.
- Relief methods include:
- Sleeping on the left side to prevent vena cava compression.
- Elevating the legs.
- Staying hydrated and exercising.
- Wearing compression socks and avoiding prolonged sitting or standing.
Nasal and Sinus Congestion
- Congestion results from elevated levels of estrogen, progesterone, and prostaglandins.
Cardiovascular System Adaptations
- Elevated red blood cell (RBC) count and volume.
- Increased plasma volume leads to decreased hemoglobin concentration.
Fetal Monitoring Techniques
- Daily fetal movement counts (FMC) are recommended after approximately 28 weeks:
- Options: Two-hour perception of ten distinct movements or one-hour perception of four movements.
- If no movement is detected post-meal, advise lying on the side.
- Vibroacoustic stimulation (VAS) is used when a non-reactive non-stress test (NST) occurs:
- Involves applying an artificial larynx on the maternal abdomen; reactive results show FHR increases.
- Contraction stress tests assess fetal heart rate (FHR) response to contractions:
- A normal (negative) result shows no FHR decelerations with three contractions.
- An abnormal (positive) result indicates late decelerations during 50% of contractions, suggesting oxygen reserve issues.
- Amniotic Fluid Index (AFI) evaluates amniotic fluid volume to check fetal well-being:
- Normal range is approximately 8cm to 24cm, while ologohydramnios and polyhydramnios indicate fetal distress.
- A biophysical profile combines NST with ultrasound assessing five indicators and score interpretation.
Diagnosing Pregnancy
Signs of Pregnancy
-
Presumptive Signs:
- Amenorrhea, nausea and vomiting, breast changes (enlargement, tenderness), fatigue, frequent urination, quickening.
-
Probable Signs:
- Uterine growth, skin hyperpigmentation (melasma and linea nigra), and ballottement.
-
Positive Signs:
- Auscultation of fetal heart sounds, palpable fetal movement, and sonographic visualization of fetal structures.
Pregnancy Tests
- Urine pregnancy tests detect human chorionic gonadotropin (hCG), with blood tests providing earlier detection.
- First-morning urine specimens yield the most accurate results for home pregnancy tests.
Preconception and Prenatal Care
Initial Prenatal Visit Components
- Comprehensive health assessment including pregnancy history and physical exam.
- Determine estimated due date (EDD), nutrition assessment, and psychosocial evaluation.
- Standard lab tests including blood type, CBC, RPR, HIV screening, hepatitis B, rubella titer, tuberculosis screen, urinalysis, and cultures.
Teratogenesis
- Teratogenesis refers to congenital malformations due to exposure to harmful agents during development.
Prenatal Education Topics
- Discuss pain relief, postpartum care, early pregnancy discomforts, breastfeeding, signs of labor, and infant care.
Obstetric History Documentation (GTPAL)
- G: Total number of pregnancies.
- T: Term infants (37+ weeks).
- P: Preterm infants.
- A: Abortions (spontaneous or induced).
- L: Living children.
Screening Recommendations
- Gestational diabetes screening occurs at 24-28 weeks.
- Group B Streptococcus (GBS) screening is done at 35-37 weeks.
Infertility Definition
- Defined as the inability to conceive and maintain a pregnancy after six months.
Pregnancy and Fetal Development
Fertilization Location
- Occurs in the outer third of the fallopian tube where sperm and oocyte nuclei merge to form a zygote.
Fetal Circulatory System Structures
- Ductus venosus connects umbilical vein to inferior vena cava.
- Foramen ovale allows blood shunting from right to left atrium.
- Ductus arteriosus connects pulmonary artery to descending aorta, directing most blood to the aorta bypassing the lungs.
Placenta Function and Formation
- Forms from both fetal (chorionic tissue) and maternal (decidual tissue) components.
- Facilitates metabolic and gas exchange via diffusion and active transport, alongside hormone production (hCG, estrogen, progesterone, hPL) essential for pregnancy maintenance.
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Description
This quiz explores the various physiologic changes that occur during pregnancy, focusing specifically on uterine adaptations and hormonal influences. It covers the significant alterations in muscle tone, circulatory changes, and the body's prepares for childbirth. Test your understanding of these essential adaptations during this vital period.
