Questions and Answers
What score on a fetal non-stress test indicates immediate delivery is needed?
Which of the following is a presumptive sign of pregnancy?
At what gestational age is quickening most likely to be felt in a primigravida?
What is the hormone detected by laboratory tests for pregnancy?
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Which of these is a probable sign of pregnancy?
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What does a score of 6/10 on a non-stress test indicate?
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When can fetal movement often first be observed by the examiner?
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Which statement about home pregnancy tests is correct?
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What defines a reactive non-stress test (NST)?
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What result from the contraction stress test is considered normal?
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What does an amniotic fluid index (AFI) below 5 cm indicate?
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What is a characteristic of a positive contraction stress test?
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Which of the following parameters indicate a normal biophysical profile?
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What does a biophysical profile primarily assess?
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Which of the following describes an abnormal AFI?
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What is the primary change that occurs to the uterine wall during pregnancy?
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What is a common limitation of the contraction stress test?
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Which hormone is responsible for muscle relaxation in the smooth muscle during pregnancy?
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What is a common cause of edema in the lower extremities during pregnancy?
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How can relief from lower extremity edema be achieved?
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What physiological factors contribute to nasal and sinus congestion during pregnancy?
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What change in lab values is typical during pregnancy due to cardiovascular adaptations?
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What is one approach to monitor daily fetal movement counts after approximately 28 weeks of pregnancy?
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What is a common symptom associated with increased gastrointestinal progesterone during pregnancy?
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What is the meaning of teratogenesis?
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When should gestational diabetes screening ideally occur during pregnancy?
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What does the 'P' in the GTPAL documentation represent?
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Which component is NOT typically included in an initial prenatal visit?
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At what stage of pregnancy is Group B Streptococcus (GBS) screening conducted?
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What does the 'L' in the GTPAL acronym signify?
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What is the typical indication for performing a urinalysis during prenatal care?
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What is included in the assessment of intimate partner violence during the initial prenatal visit?
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Which structure is developed from the trophoblast and contributes to the formation of the placenta?
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What is the primary function of the ductus arteriosus in the fetal circulatory system?
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Which of the following descriptions best explains the function of chorionic villi?
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How does the placenta contribute to hormone production during pregnancy?
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What is the role of the foramen ovale after birth?
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What component is found on the maternal side of the placenta?
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Which fetal structure is directly responsible for connecting the umbilical vein to the inferior vena cava?
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What is one of the functions of human placental lactogen (hPL)?
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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.
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Probable Signs:
- Uterine growth, skin hyperpigmentation (melasma and linea nigra), and ballottement.
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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
Explore the various physiological and hormonal changes that occur during pregnancy. This quiz covers uterine modifications, hormonal impacts on smooth muscles, and other critical adaptations. Test your knowledge on how the body prepares for childbirth and supports fetal development.
