Physiology of Pregnancy
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Questions and Answers

What cardiovascular change occurs frequently during pregnancy due to elevated levels of fibrin and fibrinogen?

  • Decreased cardiac output
  • Decreased plasma volume
  • Increased hypercoagulability (correct)
  • Increased hemoglobin levels

    • What condition related to body position can lead to decreased cardiac output in pregnancy?

  • Supine hypotensive syndrome (correct)
  • Postural hypertension
  • Vena cava syndrome
  • Orthostatic hypotension

    • Which test is conducted to analyze a sample of amniotic fluid for potential genetic abnormalities?

  • Amniocentesis (correct)
  • Biophysical Profile
  • Chorionic Villus Sampling (CVS)
  • Nonstress Test (NST)

    • In the GTPAL documentation system, what does 'P' represent?

    <p>Pre-term infants</p> Signup and view all the answers

    Which of the following hormones is NOT produced by the placenta during pregnancy?

    <p>Prolactin</p> Signup and view all the answers

    At which week is Rhogam administered if the mother is Rh-negative?

    <p>Week 28</p> Signup and view all the answers

    During which weeks is Group B streptococcus (GBS) screening performed?

    <p>Weeks 35-37</p> Signup and view all the answers

    What significant physiological changes does progesterone facilitate during pregnancy?

    <p>Breast development and relaxation of smooth muscles</p> Signup and view all the answers

    Which hormone is primarily involved in maintaining early pregnancy and is detectable in pregnancy tests?

    <p>Human Chorionic Gonadotropin (hCG)</p> Signup and view all the answers

    What is the typical timing for fetal heart tones to be auscultated using a Doppler?

    <p>By week 10-12</p> Signup and view all the answers

    During the second trimester, what is the typical development milestone where quickening occurs?

    <p>Weeks 18-20</p> Signup and view all the answers

    What condition can occur due to compression of the inferior vena cava when a pregnant woman lies on her back?

    <p>Supine hypotensive syndrome</p> Signup and view all the answers

    What is the purpose of the amniotic fluid during pregnancy?

    <p>Acts as a cushion and regulator of temperature</p> Signup and view all the answers

    At what gestational week does full term pregnancy conclude?

    <p>Week 39</p> Signup and view all the answers

    Which of the following statements accurately describes the role of the placenta during pregnancy?

    <p>It facilitates the exchange of nutrients and waste between mother and fetus.</p> Signup and view all the answers

    What is a common physiological change in the cardiovascular system during pregnancy?

    <p>Increased red blood cell count</p> Signup and view all the answers

    Which statement regarding genetic inheritance patterns is correct?

    <p>Dominant inheritance may result in the disease even if the gene is present on one chromosome.</p> Signup and view all the answers

    Which method is used to assess fetal well-being during pregnancy?

    <p>Nonstress Test (NST)</p> Signup and view all the answers

    What is a probable sign of pregnancy?

    <p>Skin hyperpigmentation</p> Signup and view all the answers

    What is the role of the placenta during pregnancy?

    <p>Exchanges gases and nutrients between mother and fetus</p> Signup and view all the answers

    What is the purpose of amniotic fluid?

    <p>Cushions the fetus and prevents adhesion of fetal parts</p> Signup and view all the answers

    Which condition results from the compression of the inferior vena cava during pregnancy?

    <p>Supine Hypotensive Syndrome</p> Signup and view all the answers

    At what gestational age is chorionic villus sampling (CVS) typically performed?

    <p>10-12 weeks</p> Signup and view all the answers

    Which of the following is NOT a common discomfort experienced during pregnancy?

    <p>Increased appetite</p> Signup and view all the answers

    What does the G in GTPAL stand for?

    <p>Gravida – Total number of pregnancies</p> Signup and view all the answers

    What is the maximum volume increase of the uterus during pregnancy?

    <p>5000 mL</p> Signup and view all the answers

    How much does blood flow to the uterus increase at term?

    <p>500-600 mL/min</p> Signup and view all the answers

    What physiological change can increase the risk of urinary stasis during pregnancy?

    <p>Progesterone-induced smooth muscle relaxation</p> Signup and view all the answers

    What is a potential complication related to cardiovascular adaptations during pregnancy?

    <p>Iron deficiency anemia</p> Signup and view all the answers

    Which of the following changes occurs in the gastrointestinal system due to increased progesterone during pregnancy?

    <p>Slowed stomach emptying</p> Signup and view all the answers

    Which hormone is primarily responsible for the relaxation of smooth muscle in the cervix during pregnancy?

    <p>Progesterone</p> Signup and view all the answers

    How much does the red blood cell count typically increase during pregnancy?

    <p>30%</p> Signup and view all the answers

    What contributes to nasal and sinus congestion during pregnancy?

    <p>Vascular engorgement and smooth muscle relaxation</p> Signup and view all the answers

    What physiological changes occur in the renal system due to increased progesterone during pregnancy?

    <p>Increased urine production and higher risk of urinary tract infections</p> Signup and view all the answers

    Which hormone is primarily responsible for maintaining early pregnancy and is detectable by urine tests around week 4?

    <p>Human Chorionic Gonadotropin (hCG)</p> Signup and view all the answers

    What is the likely reason for experiencing heartburn during pregnancy?

    <p>Slower stomach emptying and relaxation of the esophageal sphincter</p> Signup and view all the answers

    During which weeks of pregnancy does quickening, or the first awareness of fetal movement, typically occur?

    <p>Weeks 18-20</p> Signup and view all the answers

    What condition might be caused by supine hypotensive syndrome during pregnancy?

    <p>Compression of the inferior vena cava leading to hypotension</p> Signup and view all the answers

    What is the physiological significance of the enlargement of the uterus during pregnancy?

    <p>Allows for increased blood flow to the developing fetus</p> Signup and view all the answers

    What test is performed around week 20 to assess fetal anatomy?

    <p>Anatomy scan ultrasound</p> Signup and view all the answers

    The increase in blood volume and red blood cell production during pregnancy serves which purpose?

    <p>To enhance oxygen delivery to tissues and the fetus</p> Signup and view all the answers

    What primary role does the placenta play during pregnancy?

    <p>Facilitates the exchange of nutrients and waste between mother and fetus</p> Signup and view all the answers

    What are striae gravidarum, and how do they occur during pregnancy?

    <p>Stretch marks resulting from rapid skin stretching</p> Signup and view all the answers

    What is the impact of increased progesterone on gastrointestinal function during pregnancy?

    <p>Decreased gastrointestinal transit time and constipation</p> Signup and view all the answers

    What primary change occurs in the uterus to accommodate a growing fetus during pregnancy?

    <p>Hypertrophy of the uterine wall</p> Signup and view all the answers

    Which of the following accurately describes the changes in blood flow to the uterus at term during pregnancy?

    <p>Blood flow increases to 500-600 mL/min</p> Signup and view all the answers

    What commonly occurs due to the relaxation of smooth muscle from hormonal changes during pregnancy?

    <p>Increased risk of urinary stasis</p> Signup and view all the answers

    What effect does compression of the iliac veins and inferior vena cava have during pregnancy?

    <p>Increased lower extremity edema</p> Signup and view all the answers

    How does the increase in plasma volume during pregnancy affect laboratory values?

    <p>Can lead to dilutional anemia</p> Signup and view all the answers

    What changes in renal function can be attributed to increased progesterone during pregnancy?

    <p>Increased risk of urinary tract infections</p> Signup and view all the answers

    What triggers nasal and sinus congestion during pregnancy?

    <p>Vascular engorgement and smooth muscle relaxation</p> Signup and view all the answers

    What major adaptation in the fetal circulatory system enables blood to bypass the lungs?

    <p>Ductus arteriosus</p> Signup and view all the answers

    Which of the following genetic conditions is characterized by recessive inheritance and requires two copies of the mutant gene for expression?

    <p>Cystic Fibrosis</p> Signup and view all the answers

    What is the primary purpose of conducting a nonstress test (NST) during pregnancy?

    <p>To evaluate fetal heart rate responses</p> Signup and view all the answers

    What percentage increase in blood volume is typically observed in a pregnant woman by term?

    <p>30-40%</p> Signup and view all the answers

    Which physiological change is primarily responsible for the development of edema in pregnant women?

    <p>Elevated plasma volume and hormonal shifts</p> Signup and view all the answers

    What is the primary factor contributing to increased urine output during pregnancy?

    <p>Increased progesterone levels</p> Signup and view all the answers

    During which phase of pregnancy does major organ system development occur?

    <p>Embryonic Phase</p> Signup and view all the answers

    Which structure allows fetal blood to bypass the lungs during circulation?

    <p>Foramen ovale</p> Signup and view all the answers

    What is a common cause of heartburn during pregnancy?

    <p>Relaxation of the lower esophageal sphincter</p> Signup and view all the answers

    What is the significance of chorionic villus sampling (CVS) in early pregnancy?

    <p>Conducting genetic testing</p> Signup and view all the answers

    Which pregnancy-related condition is characterized by the compression of the inferior vena cava?

    <p>Supine hypotensive syndrome</p> Signup and view all the answers

    What does the 'A' in GTPAL documentation represent?

    <p>Abortions</p> Signup and view all the answers

    What condition is indicated by the objective change of skin hyperpigmentation during pregnancy?

    <p>Probable sign</p> Signup and view all the answers

    What is a contributing factor to the increased risk of gallstones during pregnancy?

    <p>Higher levels of estrogen</p> Signup and view all the answers

    What is the primary factor contributing to lower extremity edema during pregnancy?

    <p>Compression of veins in the pelvic region</p> Signup and view all the answers

    Which statement accurately describes the effect of progesterone on the gastrointestinal system during pregnancy?

    <p>Causes relaxation of the esophageal sphincter</p> Signup and view all the answers

    During which phase is the formation of the placenta initiated?

    <p>Embryonic phase</p> Signup and view all the answers

    What physiological change increases the risk of urinary tract infections (UTIs) during pregnancy?

    <p>Increased progesterone levels</p> Signup and view all the answers

    At what point during pregnancy can fetal heart tones typically be detected using Doppler technology?

    <p>Week 10-12</p> Signup and view all the answers

    What common symptom occurs during the first trimester due to hormonal changes?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What screening is typically performed around week 20 to assess the health of the fetus?

    <p>Anatomy scan ultrasound</p> Signup and view all the answers

    Which hormone produced by the placenta helps in preparing the breasts for lactation?

    <p>Human placental lactogen (hPL)</p> Signup and view all the answers

    What condition can cause supine hypotensive syndrome in pregnant women?

    <p>Supine position leading to inferior vena cava compression</p> Signup and view all the answers

    Which symptom is commonly associated with the respiratory effects of pregnancy hormones?

    <p>Epistaxis</p> Signup and view all the answers

    What physiological effect does Human Placental Lactogen (hPL) have during pregnancy?

    <p>Promotes fetal growth and prepares breasts for lactation</p> Signup and view all the answers

    What condition is commonly related to fluid retention during pregnancy?

    <p>Edema in lower extremities</p> Signup and view all the answers

    Which hormone's increase is primarily responsible for the physiological changes leading to breast enlargement during pregnancy?

    <p>Estrogen</p> Signup and view all the answers

    What is the primary function of the mucus plug formed in the cervix during pregnancy?

    <p>Seals the uterus to protect against infection</p> Signup and view all the answers

    During which period of pregnancy does the significant increase in blood volume typically occur?

    <p>Early second trimester</p> Signup and view all the answers

    What is a common consequence of lying supine during the later stages of pregnancy?

    <p>Supine hypotensive syndrome</p> Signup and view all the answers

    Which physiological change occurs primarily in the uterine environment as pregnancy progresses?

    <p>Hypertrophy of the uterine muscle</p> Signup and view all the answers

    Which of the following tests is conducted to screen for potential genetic abnormalities around week 20 of pregnancy?

    <p>Anatomy scan ultrasound</p> Signup and view all the answers

    During which weeks of the third trimester is Group B streptococcus (GBS) screening typically performed?

    <p>Weeks 35-37</p> Signup and view all the answers

    What is the significance of the amniotic fluid during pregnancy?

    <p>Provides cushioning and temperature regulation for the fetus</p> Signup and view all the answers

    Study Notes

    Uterine Changes During Pregnancy

    • The uterus expands to 20 times its pre-pregnancy size.
    • Capacity increases from 10 ml to 5000 ml to accommodate the fetus and placenta.
    • Weight increases from 70g to 1,100g.
    • Blood flow reaches 500-600 ml/min at term.

    Hormonal Impact on Smooth Muscle

    • Progesterone relaxes smooth muscle, leading to slower digestion, urinary stasis, and relaxation of the cervix and pelvic floor.
    • Estrogen and progesterone contribute to relaxation of the cervix and pelvic floor ligaments.

    Respiratory Changes

    • Estrogen, progesterone, and prostaglandins cause:
      • Dyspnea (shortness of breath)
      • Nasal and sinus congestion
      • Epistaxis (nosebleeds)

    Renal Changes

    • Increased progesterone leads to:
      • Increased urine production
      • Incontinence
      • Higher risk of UTIs

    Gastrointestinal Changes

    • Increased progesterone causes:
      • Slower stomach emptying, leading to heartburn.
      • Slower digestion and stool movement, leading to bloating, gas, and constipation.
      • Decreased gallbladder muscle tone, increasing the risk of gallstones and cholestasis.

    Lower Extremity Edema During Pregnancy

    • Compression of the iliac veins and inferior vena cava increases venous pressure and reduces blood flow.
    • Relief can be achieved by elevating the legs, avoiding prolonged standing, and wearing compression stockings.

    Nasal and Sinus Congestion During Pregnancy

    • Estrogen, progesterone, and prostaglandins cause blood vessel swelling and smooth muscle relaxation in the nose and sinuses, leading to congestion.

    Cardiovascular System Adaptations

    • Red blood cell count increases by 30%.
    • Red blood cell volume increases by 18-33%.
    • Plasma volume increases by 50%.
    • White blood cell count can increase up to 16,000 in the absence of infection.
    • Iron deficiency anemia and reduced hemoglobin levels are potential complications.

    Conception and Embryonic Phase (Weeks 0-8)

    • Fertilization occurs in a fallopian tube.
    • Rapid cell division and development of major organs and body systems take place.
    • The placenta begins to form during implantation.
    • Heartbeat detectable by week 4.
    • Urine pregnancy tests can detect hCG hormone by week 4.
    • Fetal heart tones heard by Doppler by weeks 10-12.
    • Chorionic villus sampling can be performed for genetic testing at weeks 10-12.

    First Trimester (Weeks 0-14)

    • Nausea and vomiting are common due to hormonal changes.
    • Breast enlargement, tenderness, and tingling begin.
    • Multiple marker/NIPT/cell-free DNA blood tests and nuchal translucency ultrasounds can be used for screening in weeks 10-14.
    • Initial prenatal visit includes a comprehensive health and risk assessment, physical exam, and lab tests.

    Second Trimester (Weeks 15-28)

    • Quickening (first awareness of fetal movement) occurs around weeks 18-20.
    • Fundal height reaches the level of the umbilicus by week 20.
    • Anatomy scan ultrasound is performed at week 20.
    • Amniocentesis can be performed for genetic testing in weeks 15-20.
    • Screening for gestational diabetes typically takes place in weeks 24-28.
    • Repeat CBC and syphilis testing, as well as Rhogam administration if Rh-negative, are conducted at week 28.

    Third Trimester (Weeks 29-40)

    • Group B streptococcus (GBS) screening is performed at weeks 35-37.
    • Ultrasounds, amniotic fluid index (AFI), biophysical profile (BPP), fetal movement monitoring, non-stress test (NST), and vibroacoustic stimulation (VAS) are used to assess fetal well-being throughout this trimester.
    • Early term is reached at week 37.
    • Full term is reached at week 39.
    • Education on pain relief options, postpartum care, breastfeeding, and signs of labor are provided towards the end of the third trimester.

    Key Hormones & Physiological Changes

    • Estrogen & Progesterone: responsible for uterine growth, breast development, and relaxation of smooth muscles.
    • Human Chorionic Gonadotropin (hCG): produced by the developing placenta and is detectable in pregnancy tests. It also helps maintain the early pregnancy.
    • Human Placental Lactogen (hPL): promotes fetal growth and helps prepare the breasts for lactation.

    Key Organs & Structures

    • Uterus: houses and nourishes the developing fetus.
    • Placenta: facilitates the exchange of nutrients, oxygen, and waste products between the mother and fetus. It also produces hormones.
    • Umbilical Cord: connects the fetus to the placenta and transports oxygen, nutrients, and removes waste products.
    • Amniotic Fluid: surrounds the fetus, providing cushioning, temperature regulation, and freedom of movement.
    • Fetus: undergoes remarkable transformations throughout pregnancy.

    Uterine Changes in Pregnancy

    • The uterus undergoes significant changes during pregnancy, including hypertrophy (enlargement), increased vascularity (blood flow), mucus plug formation to seal the cervix, and cessation of the menstrual cycle.

    Hormonal Impact on Pregnancy

    • Pregnancy hormones, particularly estrogen, progesterone, and prostaglandins, influence various bodily systems.
    • Respiratory: Increased estrogen and progesterone cause dyspnea (shortness of breath), nasal congestion, and epistaxis (nosebleeds).
    • Renal: Increased urine output, risk of UTI, and incontinence are common.
    • GI: Heartburn, constipation, and increased risk of gallstones are associated with hormonal changes.
    • Musculoskeletal: Softened joints, altered gait, and lower back pain are common.
    • Cardiovascular: Increased red blood cell count, plasma volume, and hypercoagulability (increased clotting) are part of the physiological adaptations of pregnancy.
    • Supine Hypotensive Syndrome: Compression of the inferior vena cava by the enlarged uterus can reduce cardiac output, leading to a drop in blood pressure when lying on the back.

    Common Pregnancy Discomforts & Relief

    • Edema: Elevation of legs, adequate hydration, and compression socks can help alleviate edema.
    • Heartburn: Progesterone relaxes the esophageal sphincter, leading to heartburn. Small meals and antacids can provide relief.
    • Nasal Congestion: Estrogen, progesterone, and prostaglandins contribute to vascular engorgement, causing nasal congestion.

    Genetic Inheritance Patterns

    • Dominant Inheritance: Only one copy of the affected gene is needed for the trait to be expressed. (e.g., Huntington’s Disease).
    • Recessive Inheritance: Two copies of the affected gene are required for the trait to be expressed. (e.g., Sickle Cell Anemia, Cystic Fibrosis, Tay-Sachs).
    • X-linked Inheritance: Genes are located on the X chromosome. More common in males. (e.g., Hemophilia, Duchenne’s Muscular Dystrophy).

    Antenatal Testing & Fetal Well-being

    • Chorionic Villus Sampling (CVS): Performed between 10-12 weeks of pregnancy to obtain a sample of chorionic villi for genetic testing.
    • Amniocentesis: Performed between 15-20 weeks of pregnancy to obtain amniotic fluid for chromosomal and genetic testing.
    • Nonstress Test (NST): Measures fetal heart rate response to fetal movement.
    • Fetal Well-being Assessment: Biophysical profile, vibroacoustic stimulation, and contraction stress test help assess fetal well-being.

    Diagnosing Pregnancy: Signs and Symptoms

    • Presumptive Signs: Subjective changes that can be caused by other factors, including amenorrhea, nausea, breast changes, fatigue, urinary frequency, and fetal movement (quickening).
    • Probable Signs: Objective changes that are more likely to indicate pregnancy, such as uterine and abdominal growth, skin hyperpigmentation (melasma, linea nigra), and ballottement (a rebounding sensation when the cervix is tapped).
    • Positive Signs: Definite signs that confirm pregnancy, including auscultation of fetal heart sounds, fetal movements palpable by the examiner, and sonographic visualization of the fetus.

    Preconception & Prenatal Care

    • Initial Prenatal Visit: Comprehensive health assessment, calculation of estimated due date (EDD), blood typing, Rh factor determination, CBC, HIV and syphilis testing, and urinalysis.
    • Teratogenesis: Malformations caused by teratogens (substances that can harm a developing fetus).
    • Prenatal Education Topics:
      • 1st Trimester: Early discomforts and pregnancy milestones.
      • 2nd Trimester: Signs of labor and preparing for childbirth.
      • 3rd Trimester: Pain relief options, breastfeeding, and postpartum care.

    GTPAL Documentation

    • A system used to document a woman's obstetric history.
      • G: Gravida - number of pregnancies.
      • T: Term infants - number of babies born at or after 37 weeks.
      • P: Pre-term infants - number of babies born between 20 and 37 weeks.
      • A: Abortions - number of pregnancies that ended before 20 weeks.
      • L: Living children - number of living children.

    Screening & Testing Timeline

    • Gestational Diabetes Screening: Usually done between 24-28 weeks of pregnancy.
    • Group B Strep (GBS) Screening: Performed between 35-37 weeks to determine if the woman carries GBS bacteria, which can be harmful to the newborn.

    Pregnancy and Fetal Development: Key Structures and Milestones

    • Fetal Circulatory System:

      • Ductus venosus: Connects the umbilical vein to the inferior vena cava, bypassing the liver.
      • Foramen ovale: An opening between the right and left atria, allowing blood to bypass the lungs.
      • Ductus arteriosus: Connects the pulmonary artery to the aorta, allowing blood to bypass the lungs.

    • Placenta Formation & Function: The placenta is a vital organ that exchanges gases, nutrients, and waste products between the mother and fetus. It produces hormones essential for pregnancy, including estrogen, progesterone, human chorionic gonadotropin (hCG), and human placental lactogen (hPL).

    • Umbilical Cord Anatomy: The umbilical cord contains two arteries carrying deoxygenated blood from the fetus to the placenta and one vein carrying oxygenated blood from the placenta to the fetus.

    • Amniotic Fluid Function: Cushions the fetus and protects it from injury. Prevents adhesion of fetal parts. Allows for fetal movement and development.

    • Embryonic Phase: From implantation to 8 weeks. During this period, major organ systems develop.

    • Fetal Heart Auscultation: Usually heard at 10-12 weeks.

    • Fundal Height at 20 Weeks: The uterus should be at the level of the umbilicus.

    • Term Pregnancy: Typically 39 weeks.

    Physiologic Adaptations to Pregnancy

    • Uterine Changes: The uterus undergoes significant changes during pregnancy, including hypertrophy (enlargement), increased vascularity (blood flow), mucus plug formation to seal the cervix, and cessation of the menstrual cycle.
    • Hormonal Impact: Pregnancy hormones, particularly estrogen, progesterone, and prostaglandins, influence various bodily systems.
      • Respiratory: Increased estrogen and progesterone cause dyspnea (shortness of breath), nasal congestion, and epistaxis (nosebleeds).

    Renal Changes

    • Progesterone can increase urine output, making pregnant women more vulnerable to UTIs and urinary incontinence.

    Gastrointestinal Changes

    • Progesterone causes relaxation of the esophageal sphincter, leading to heartburn and constipation.
    • Increased risk of gallstones.

    Musculoskeletal Changes

    • Joint softening and altered gait can lead to lower back pain.

    Cardiovascular Changes

    • Increased red blood cells and plasma volume during pregnancy.
    • Hypercoagulability due to elevated fibrin and fibrinogen.
    • Hemoglobin and hematocrit levels may decrease despite increased red blood cells.

    Supine Hypotensive Syndrome

    • The enlarged uterus compresses the inferior vena cava when lying on the back, decreasing cardiac output and causing low blood pressure.

    Common Pregnancy Discomforts

    • Leg swelling (edema) is common, especially in the lower extremities.
    • Elevation, hydration, and compression socks can help alleviate edema.
    • Heartburn is caused by progesterone relaxation of the esophageal sphincter.
    • Eating small, frequent meals and using antacids can manage heartburn.
    • Nasal congestion is caused by vascular engorgement in the nasal passages due to estrogen, progesterone, and prostaglandins.

    Genetics

    • Dominant traits require only one copy of the abnormal gene for expression, for example, Huntington's disease.
    • Recessive traits need two copies of the abnormal gene for expression, examples include Sickle Cell Anemia, Cystic Fibrosis, and Tay-Sachs disease.
    • X-linked traits are carried on the X chromosome and males, with only one X chromosome, are more likely to express these traits, for example, Hemophilia and Duchenne's Muscular Dystrophy.

    Antenatal Testing

    • Chorionic villus sampling (CVS) is performed between 10-12 weeks of gestation to analyze placental tissue for genetic abnormalities.
    • Amniocentesis is conducted between 15-20 weeks to analyze amniotic fluid for chromosomal defects and other genetic conditions.
    • Nonstress test (NST) monitors fetal heart rate responses to fetal movements to assess fetal well-being.
    • A normal NST shows two accelerations of at least 15 beats per minute lasting 15 seconds within a 20-minute period.
    • Other fetal well-being tests include the biophysical profile, vibroacoustic stimulation, and contraction stress test.

    Diagnosing Pregnancy

    • Presumptive signs suggest pregnancy but are not conclusive, examples include missed period, nausea, breast changes, fatigue, urinary frequency, and quickening.
    • Probable signs strongly suggest pregnancy but are not definitive, examples include uterine and abdominal growth, skin hyperpigmentation, and ballottement.
    • Positive signs are definitive signs of pregnancy that only occur with pregnancy, examples include auscultation of a fetal heartbeat, palpation of fetal movement, and sonographic visualization of the fetus.

    Preconception & Prenatal Care

    • Initial prenatal visit includes a health assessment, EDD calculation, blood type and Rh factor determination, CBC, HIV and syphilis testing, and urinalysis.
    • Teratogenesis refers to the development of birth defects caused by environmental factors called teratogens.
    • Prenatal education covers early pregnancy discomforts and milestones in the 1st trimester, signs of labor and common pregnancy changes in the 2nd trimester, and pain relief options, breastfeeding preparation, and postpartum care in the 3rd trimester.

    GTPAL Documentation

    • GTPAL documents a woman's obstetric history.
    • G: Gravida (number of pregnancies, including current pregnancy).
    • T: Term infants (births at 37 weeks or more).
    • P: Pre-term infants (births between 20 and 37 weeks).
    • A: Abortions (spontaneous or induced).
    • L: Living children.

    Screening & Testing Timeline

    • Gestational Diabetes Screening is typically performed between 24-28 weeks of gestation to identify gestational diabetes.
    • Group B Strep (GBS) Screening is conducted between 35-37 weeks to look for the presence of Group B Streptococcus bacteria in the vagina and rectum.

    Pregnancy & Fetal Development

    • Fetal circulatory system:
      • Ductus venosus: connects the umbilical vein to the inferior vena cava, bypassing the liver.
      • Foramen ovale: an opening between the right and left atria of the heart, shunting blood away from the lungs.
      • Ductus arteriosus: connects the pulmonary artery to the aorta, avoiding the lungs.
    • Placenta formation & function:
      • Formed from maternal and fetal tissues.
      • Facilitates gas exchange between the mother and fetus.
      • Produces essential hormones like estrogen, progesterone, hCG, and hPL for pregnancy maintenance and fetal development.
    • Umbilical cord anatomy:
      • Connects the fetus to the placenta.
      • Consists of two arteries carrying deoxygenated blood away from the fetus and one vein carrying oxygenated blood towards the fetus.
    • Amniotic fluid function:
      • Cushions the fetus.
      • Prevents adhesion to the amniotic sac.
      • Allows fetal movement and development.
    • Embryonic phase:
      • Begins at implantation and lasts until 8 weeks of gestation.
      • Organogenesis (organ formation) occurs during this phase.
    • Fetal heart auscultation:
      • Typically heard between 10-12 weeks of gestation.
    • Fundal height at 20 weeks:
      • The fundus (top of the uterus) is usually located at the level of the umbilicus at 20 weeks of gestation.
    • Term pregnancy:
      • Considered 39 weeks from the first day of the last menstrual period.

    Uterine Changes

    • Uterus increases in size 20 times its pre-pregnancy size
    • Capacity increases from 10mL to 5000mL
    • Weight increases from 70g to 1100g
    • Blood flow to uterus increases to 500-600mL/min by term
    • Uterine wall thickens to accommodate the growing fetus
    • Vaginal muscles and connective tissue soften to prepare for childbirth
    • Cervical glands produce a mucus plug to protect from infection
    • Increased vaginal discharge (leukorrhea) due to blood flow and gland growth
    • Menstruation and ovulation stop

    Hormonal Impact

    • Progesterone relaxes smooth muscle, leading to:
      • Slower gastrointestinal transit
      • Increased risk of urinary stasis
      • Relaxation of the cervix and pelvic floor ligaments

    Respiratory Changes

    • Dyspnea, nasal and sinus congestion, and epistaxis due to estrogen, progesterone, and prostaglandins

    Renal Changes

    • Increased urine output, incontinence, and increased risk of UTIs due to increased progesterone

    Gastrointestinal Changes

    • Slow stomach emptying, reflux of gastric contents (heartburn), bloating, flatulence, constipation, and increased risk of gallstone formation and cholestasis due to increased progesterone

    Lower Extremity Edema

    • Compression of iliac veins and inferior vena cava causes increased venous pressure and decreased blood flow leading to edema
    • Relief:
      • Elevate legs
      • Avoid prolonged standing
      • Wear compression stockings

    Cardiovascular System Adaptations and Lab Values

    • Red blood cell count increases by 30%
    • Red blood cell volume increases by 18-33%
    • Plasma volume increases by 50%
    • White blood cell count can increase up to 16,000 in the absence of infection
    • Potential complications: Iron deficiency anemia and reduced hemoglobin levels

    Pregnancy Timeline

    • Conception- 8 Weeks (Embryonic Phase)
      • Fertilization occurs in fallopian tube
      • Rapid cell division and organ development occur
      • Placenta formation begins
      • Heartbeat detectable by week 4
      • Urine pregnancy tests detect hCG by week 4
      • Fetal heart tones heard by Doppler at weeks 10-12
      • Chorionic villus sampling can be performed during this phase
    • First Trimester (0-14 Weeks)
      • Weeks 2-12: Common symptoms include nausea and vomiting due to hormonal changes (hCG)
      • Weeks 2-3: Breast enlargement, tenderness, and tingling begin.
      • Weeks 10-14: Multiple marker/NIPT/cell-free DNA blood tests and nuchal translucency ultrasounds screen for fetal abnormalities.
      • Initial prenatal visit includes a comprehensive health and risk assessment, physical exam, and laboratory tests.
    • Second Trimester (15-28 Weeks)
      • Weeks 18-20: Quickening (first awareness of fetal movement) occurs. Fundal height reaches the level of the umbilicus.
      • Week 20: Anatomy scan ultrasound is performed.
      • Weeks 15-20: Amniocentesis can be performed for genetic testing.
      • Weeks 24-28: Screening for gestational diabetes occurs.
      • Week 28: Repeat CBC and syphilis testing are performed. Rhogam administration (if Rh-negative) is given to prevent maternal sensitization.
    • Third Trimester (29-40 Weeks)
      • Week 35-37: Group B streptococcus (GBS) screening is performed.
      • Weeks 29-40: Ultrasound, amniotic fluid index (AFI), biophysical profile (BPP), fetal movement monitoring, non-stress test (NST), and vibroacoustic stimulation (VAS) are used to assess fetal well-being.
      • Week 37: Early term is reached.
      • Week 39: Full term is reached.
      • Education on pain relief options, postpartum care, breastfeeding, and signs of labor is provided.

    Ongoing Throughout Pregnancy

    • Uterus enlarges significantly, increasing in size and capacity.
    • Blood volume and red blood cell production increase.
    • Hormonal changes (estrogen and progesterone) cause various physiological changes.
    • Supine hypotensive syndrome may occur due to compression of the inferior vena cava.
    • Common digestive issues include heartburn and constipation.
    • Edema in the lower extremities, nasal congestion, and dyspnea can occur.
    • Softening of joints and altered gait are common.
    • Striae gravidarum (stretch marks) may develop.

    Pregnancy Hormones

    • Estrogen & Progesterone: Responsible for many physiological changes, including uterine growth, breast development, and smooth muscle relaxation.
    • Human Chorionic Gonadotropin (hCG): Produced by the developing placenta and detected in pregnancy tests. Helps maintain early pregnancy.
    • Human Placental Lactogen (hPL): Promotes fetal growth and prepares breasts for lactation.

    Key Structures in Pregnancy

    • Uterus: Houses and nourishes the developing fetus.
    • Placenta: Facilitates the exchange of nutrients, oxygen, and waste products between the mother and fetus. It also produces hormones.
    • Umbilical Cord: Connects the fetus to the placenta and contains blood vessels that transport oxygen and nutrients and remove waste products.
    • Amniotic Fluid: Surrounds the fetus, providing cushioning, temperature regulation, and freedom of movement.
    • Fetus: The developing human being that undergoes remarkable transformations throughout pregnancy.

    Conception & Embryonic Phase (Weeks 0-8)

    • Fertilization occurs in the fallopian tube, marking the start of pregnancy.
    • Rapid cell division and development of major organs and body systems take place.
    • Placenta formation begins.
    • Heartbeat is detectable around week 4.
    • Urine pregnancy tests can detect human chorionic gonadotropin (hCG) hormone at week 4.
    • Fetal heart tones can be auscultated by Doppler at weeks 10-12.
    • Chorionic villus sampling can be performed for genetic testing at weeks 10-12.

    First Trimester (Weeks 0-14)

    • Nausea and vomiting are common due to hormonal changes.
    • Breast enlargement, tenderness, and tingling begin.
    • Multiple marker/NIPT/cell-free DNA blood tests and nuchal translucency ultrasounds can be used for screening.
    • Initial prenatal visit includes a comprehensive health and risk assessment, physical exam, and lab tests (blood type, Rh factor, antibody screen, CBC, syphilis/HIV/Hepatitis/PPD screen, urinalysis, gonorrhea/chlamydia).

    ### Second Trimester (Weeks 15-28)

    • Quickening (first awareness of fetal movement) occurs at weeks 18-20.
    • Fundal height reaches the level of the umbilicus at weeks 18-20.
    • Anatomy scan ultrasound is performed at week 20.
    • Amniocentesis can be performed for genetic testing at weeks 15-20.
    • Screening for gestational diabetes occurs at weeks 24-28.
    • Repeat CBC and syphilis testing are performed at week 28.
    • Rhogam administration is given at week 28 if the mother is Rh-negative.

    Third Trimester (Weeks 29-40)

    • Group B streptococcus (GBS) screening is performed at weeks 35-37.
    • Ultrasounds, amniotic fluid index (AFI), biophysical profile (BPP), fetal movement monitoring, non-stress test (NST), and vibroacoustic stimulation (VAS) are used to assess fetal well-being.
    • Early term is reached at week 37.
    • Full term is reached at week 39.
    • Education is provided on pain relief options, postpartum care, breastfeeding, and signs of labor.

    Key Hormones & Physiological Changes

    • Estrogen & Progesterone: These hormones contribute to numerous physiological changes, including uterine growth, breast development, and relaxation of smooth muscles.
    • Human Chorionic Gonadotropin (hCG): This hormone is produced by the developing placenta and detectable in pregnancy tests. It also helps maintain the early pregnancy.
    • Human Placental Lactogen (hPL): This hormone promotes fetal growth and prepares the breasts for lactation.

    Key Organs & Structures

    • Uterus: Houses and nourishes the developing fetus.
    • Placenta: Facilitates the exchange of nutrients, oxygen, and waste products between the mother and fetus. It also produces hormones.
    • Umbilical Cord: Connects the fetus to the placenta and transports oxygen, nutrients, and removes waste products.
    • Amniotic Fluid: Surrounds the fetus, providing cushioning, temperature regulation, and freedom of movement.
    • Fetus: Undergoes remarkable transformations throughout pregnancy.

    Conception and Early Development (Embryonic Phase - 8 Weeks)

    • Fertilization occurs in one of the fallopian tubes
    • Rapid cell division and development of major organs and body systems take place in weeks 1-8
    • The placenta begins to form during implantation
    • The heart begins to beat around week 4
    • Urine pregnancy tests can detect the presence of hCG hormone starting at week 4
    • Fetal heart tones can be auscultated using a Doppler by week 10-12
    • Chorionic villus sampling can be performed for genetic testing at week 10-12

    First Trimester (0-14 Weeks)

    • Nausea and vomiting are common in weeks 2-12 due to hormonal changes, specifically the increase in hCG
    • Breast enlargement, tenderness, and tingling begin in weeks 2-3
    • Multiple marker/NIPT/cell-free DNA blood tests and nuchal translucency ultrasounds can be performed for screening in weeks 10-14
    • Initial prenatal visit typically includes a comprehensive health and risk assessment, physical exam, and lab tests (blood type, Rh factor, antibody screen, CBC, syphilis/HIV/Hepatitis/PPD screen, urinalysis, gonorrhea/chlamydia)

    Second Trimester (15-28 Weeks)

    • Quickening, the first awareness of fetal movement, typically occurs around weeks 18-20
    • Fundal height reaches the level of the umbilicus by week 20
    • Anatomy scan ultrasound is performed at week 20
    • Amniocentesis can be performed for genetic testing in weeks 15-20
    • Screening for gestational diabetes typically takes place in weeks 24-28
    • Repeat CBC and syphilis testing, as well as Rhogam administration if Rh-negative, are conducted at week 28

    Third Trimester (29-40 Weeks)

    • Group B streptococcus (GBS) screening is performed at weeks 35-37
    • Ultrasounds, amniotic fluid index (AFI), biophysical profile (BPP), fetal movement monitoring, non-stress test (NST), and vibroacoustic stimulation (VAS) are used to assess fetal well-being throughout this trimester
    • Early term is reached at week 37
    • Full term is reached at week 39
    • Education on pain relief options, postpartum care, breastfeeding, and signs of labor are provided towards the end of the third trimester

    Ongoing Throughout Pregnancy

    • The uterus significantly enlarges, increasing in size and capacity
    • Increased blood volume and red blood cell production occur to support fetal growth
    • Hormonal changes (estrogen and progesterone) cause numerous physiological changes throughout pregnancy
    • Supine hypotensive syndrome can occur due to compression of the inferior vena cava when lying on the back
    • Digestive issues like heartburn and constipation are common
    • Edema in lower extremities, nasal congestion, and dyspnea can occur due to fluid retention
    • Softening of joints and altered gait are typical pregnancy symptoms
    • Striae gravidarum (stretch marks) may develop as the skin stretches

    Cast of Characters

    • Estrogen & Progesterone: These hormones are crucial for pregnancy and are responsible for many physiological changes, including uterine growth, breast development, and relaxation of smooth muscles
    • Human Chorionic Gonadotropin (hCG): This hormone is produced by the developing placenta and is detected in pregnancy tests. It also helps maintain early pregnancy.
    • Human Placental Lactogen (hPL): This hormone promotes fetal growth and helps prepare the breasts for lactation.
    • Uterus: This muscular organ houses and nourishes the developing fetus.
    • Placenta: This organ develops during pregnancy and acts as a lifeline, facilitating the exchange of nutrients, oxygen, and waste products between the mother and fetus. It also produces hormones.
    • Umbilical Cord: This cord connects the fetus to the placenta and contains blood vessels that transport oxygen and nutrients to the fetus and remove waste products back to the placenta.
    • Amniotic Fluid: This fluid surrounds the fetus, providing cushioning, temperature regulation, and freedom of movement.
    • Fetus: The developing human being undergoes remarkable transformations throughout pregnancy.

    Uterine Changes in Pregnancy

    • Uterus undergoes hypertrophy, increasing in size and capacity.
    • Vascularity of the uterus increases to support fetal growth and development.
    • A mucus plug forms in the cervix, sealing the uterus and protecting the fetus from infection.
    • Menstrual cycle ceases due to hormonal changes.

    Hormonal Impact on Pregnancy

    • Estrogen, progesterone, and prostaglandins influence various physiological changes.
    • Respiratory: Dyspnea (shortness of breath), nasal congestion, and epistaxis (nosebleeds) can occur.
    • Renal: Increased urine output, risk of UTI, and incontinence are common.
    • GI: Heartburn, constipation, and increased risk of gallstones are associated with hormonal changes.
    • Musculoskeletal: Softened joints, altered gait, and lower back pain are common.
    • Cardiovascular: Increased red blood cell count, plasma volume, and hypercoagulability (increased clotting) are part of the physiological adaptations of pregnancy.

    Supine Hypotensive Syndrome:

    • Compression of the inferior vena cava by the enlarged uterus can reduce cardiac output, leading to a drop in blood pressure when lying on the back.

    Common Pregnancy Discomforts & Relief

    • Edema: Elevation of legs, adequate hydration, and compression socks can help alleviate edema.
    • Heartburn: Progesterone relaxes the esophageal sphincter, leading to heartburn. Small meals and antacids can provide relief.
    • Nasal Congestion: Estrogen, progesterone, and prostaglandins contribute to vascular engorgement, causing nasal congestion.

    ### Genetic Inheritance Patterns

    • Dominant Inheritance: Only one copy of the affected gene is needed for the trait to be expressed. Example: Huntington’s Disease.
    • Recessive Inheritance: Two copies of the affected gene are required for the trait to be expressed. Examples: Sickle Cell Anemia, Cystic Fibrosis, Tay-Sachs.
    • X-linked Inheritance: Genes are located on the X chromosome. More common in males. Examples: Hemophilia, Duchenne’s Muscular Dystrophy.

    Antenatal Testing & Fetal Well-being

    • Chorionic Villus Sampling (CVS): A procedure performed between 10-12 weeks of pregnancy to obtain a sample of chorionic villi for genetic testing.
    • Amniocentesis: A procedure performed between 15-20 weeks of pregnancy to obtain amniotic fluid for chromosomal and genetic testing.
    • Nonstress Test (NST): Measures fetal heart rate response to fetal movement.
    • Fetal Well-being Assessment: Biophysical profile, vibroacoustic stimulation, and contraction stress test help assess fetal well-being.

    Diagnosing Pregnancy: Signs and Symptoms

    • Presumptive Signs: Subjective changes that can be caused by other factors, including amenorrhea, nausea, breast changes, fatigue, urinary frequency, and fetal movement (quickening).
    • Probable Signs: Objective changes that are more likely to indicate pregnancy, such as uterine and abdominal growth, skin hyperpigmentation (melasma, linea nigra), and ballottement (a rebounding sensation when the cervix is tapped).
    • Positive Signs: Definite signs that confirm pregnancy, including auscultation of fetal heart sounds, fetal movements palpable by the examiner, and sonographic visualization of the fetus.

    Preconception & Prenatal Care

    • Initial Prenatal Visit: Comprehensive health assessment, calculation of estimated due date (EDD), blood typing, Rh factor determination, CBC, HIV and syphilis testing, and urinalysis.
    • Teratogenesis: Malformations caused by teratogens (substances that can harm a developing fetus).

    Prenatal Education Topics:

    • 1st Trimester: Early discomforts and pregnancy milestones.
    • 2nd Trimester: Signs of labor and preparing for childbirth.
    • 3rd Trimester: Pain relief options, breastfeeding, and postpartum care.

    GTPAL Documentation

    • A system used to document a woman's obstetric history.
    • G: Gravida - number of pregnancies.
    • T: Term infants - number of babies born at or after 37 weeks.
    • P: Pre-term infants - number of babies born between 20 and 37 weeks.
    • A: Abortions - number of pregnancies that ended before 20 weeks.
    • L: Living children - number of living children.

    Screening & Testing Timeline

    • Gestational Diabetes Screening: Usually done between 24-28 weeks of pregnancy.
    • Group B Strep (GBS) Screening: Performed between 35-37 weeks to determine if the woman carries GBS bacteria, which can be harmful to the newborn.

    Pregnancy and Fetal Development: Key Structures and Milestones

    • Fetal Circulatory System:

      • Ductus venosus: Connects the umbilical vein to the inferior vena cava, bypassing the liver.
      • Foramen ovale: An opening between the right and left atria, allowing blood to bypass the lungs.
      • Ductus arteriosus: Connects the pulmonary artery to the aorta, allowing blood to bypass the lungs.

    • Placenta Formation & Function:

      • The placenta is a vital organ that exchanges gases, nutrients, and waste products between the mother and fetus. It produces hormones essential for pregnancy, including estrogen, progesterone, human chorionic gonadotropin (hCG), and human placental lactogen (hPL).

    • Umbilical Cord Anatomy: The umbilical cord contains two arteries carrying deoxygenated blood from the fetus to the placenta and one vein carrying oxygenated blood from the placenta to the fetus.

    • Amniotic Fluid Function:

      • Cushions the fetus and protects it from injury.
      • Prevents adhesion of fetal parts.
      • Allows for fetal movement and development.

    • Embryonic Phase: From implantation to 8 weeks. During this period, major organ systems develop.

    • Fetal Heart Auscultation: Usually heard at 10-12 weeks.

    • Fundal Height at 20 Weeks: The uterus should be at the level of the umbilicus.

    • Term Pregnancy: Typically 39 weeks.

    Physiologic Adaptations to Pregnancy

    • Uterine Changes: The uterus undergoes significant changes during pregnancy, including hypertrophy (enlargement), increased vascularity (blood flow), mucus plug formation to seal the cervix, and cessation of the menstrual cycle.
    • Hormonal Impact: Pregnancy hormones, particularly estrogen, progesterone, and prostaglandins, influence various bodily systems.
    • Respiratory: Increased estrogen and progesterone cause dyspnea (shortness of breath), nasal congestion, and epistaxis (nosebleeds).

    Renal Changes During Pregnancy

    • Progesterone increases urine output causing more frequent urination, leading to a higher risk of urinary tract infections (UTIs) and urinary incontinence.

    Gastrointestinal Changes During Pregnancy

    • Progesterone relaxes the esophageal sphincter, causing heartburn.
    • Progesterone can also lead to constipation and an increased risk of gallstones.

    Musculoskeletal Changes During Pregnancy

    • Hormonal changes cause joint softening and altered gait.
    • These changes can lead to lower back pain.

    Cardiovascular Changes During Pregnancy

    • Pregnancy increases red blood cell count and plasma volume, leading to hypervolemia.
    • Increased fibrin and fibrinogen levels cause hypercoagulability, increasing clotting risk.
    • Hemoglobin and hematocrit levels can decrease despite the increased red blood cell count.

    Supine Hypotensive Syndrome

    • The enlarging uterus can compress the inferior vena cava when lying on one's back.
    • This compression can reduce cardiac output leading to low blood pressure.

    Common Pregnancy Discomforts

    • Edema: Swelling, especially in the lower extremities, can be managed with elevation, hydration, and compression socks.
    • Heartburn: Caused by progesterone relaxation of the esophageal sphincter. Manage by eating small frequent meals and using antacids.
    • Nasal Congestion: Caused by vascular engorgement in the nasal passages due to estrogen, progesterone, and prostaglandins.

    Genetics

    • Dominant inheritance: Only one copy of the abnormal gene is needed for the trait to be expressed.
      • Example: Huntington's Disease
    • Recessive inheritance: Two copies of the abnormal gene are needed for the trait to be expressed.
      • Examples: Sickle Cell Anemia, Cystic Fibrosis, Tay-Sachs disease.
    • X-linked inheritance: Traits are carried on the X chromosome.
      • Males are more susceptible as they have only one X chromosome.
      • Examples: Hemophilia, Duchenne's Muscular Dystrophy

    Antenatal Testing

    • Chorionic Villus Sampling (CVS): Performed between 10-12 weeks of gestation, CVS analyzes a sample of placental tissue for genetic abnormalities.
    • Amniocentesis: Performed between 15-20 weeks of gestation, amniocentesis analyzes amniotic fluid for chromosomal defects and other genetic conditions.
    • Nonstress Test (NST): Assesses fetal well-being by monitoring fetal heart rate responses to fetal movements.
      • A normal NST shows two accelerations of at least 15 beats per minute lasting 15 seconds within a 20-minute period.
    • Other tests for fetal well-being: Biophysical profile, vibroacoustic stimulation, and contraction stress test.

    Diagnosing Pregnancy

    • Presumptive signs: Subjective signs suggesting pregnancy but not conclusive.
      • Examples: amenorrhea, nausea, breast changes, fatigue, urinary frequency, and quickening.
    • Probable signs: Objective signs strongly suggesting pregnancy, but not definitive.
      • Examples: uterine and abdominal growth, skin hyperpigmentation, and ballotement.
    • Positive signs: Definitive signs of pregnancy, only occurring with pregnancy.
      • Examples: auscultation of a fetal heartbeat, palpation of fetal movement, and sonographic visualization of the fetus.

    Preconception & Prenatal Care

    • Initial Prenatal Visit:
      • Comprehensive health assessment
      • Calculation of the Estimated Delivery Date (EDD)
      • Blood type and Rh factor determination
      • Complete blood count (CBC)
      • HIV and syphilis testing
      • Urinalysis
    • Teratogenesis: The development of birth defects caused by environmental factors called teratogens
    • Prenatal Education Topics:
      • 1st Trimester: Early pregnancy discomforts and milestones.
      • 2nd Trimester: Signs of labor and common pregnancy changes.
      • 3rd Trimester: Pain relief options during labor, breastfeeding preparation, and postpartum care.

    GTPAL Documentation

    • Used to document a woman's obstetric history:
      • G: Gravida (number of pregnancies, including current pregnancy)
      • T: Term infants (births at 37 weeks or more)
      • P: Pre-term infants (births between 20 and 37 weeks)
      • A: Abortions (spontaneous or induced)
      • L: Living children

    Screening & Testing Timeline

    • Gestational Diabetes Screening: Performed between 24-28 weeks of gestation to identify gestational diabetes.
    • Group B Strep (GBS) Screening: Conducted between 35-37 weeks to screen for Group B Streptococcus bacteria.

    Pregnancy & Fetal Development

    • Fetal Circulatory System:
      • Ductus venosus: Connects the umbilical vein to the inferior vena cava, bypassing the liver.
      • Foramen ovale: An opening between the right and left atria of the heart, shunting blood away from the lungs.
      • Ductus arteriosus: Connects the pulmonary artery to the aorta, avoiding the lungs.
    • Placenta Formation & Function:
      • Formed from maternal and fetal tissues.
      • Gas Exchange: Facilitates oxygen and carbon dioxide exchange between the mother and fetus.
      • Hormone Production: Produces estrogen, progesterone, hCG, and hPL, vital for pregnancy maintenance and fetal development.
    • Umbilical Cord Anatomy:
      • Connects the fetus to the placenta.
      • Consists of two arteries carrying deoxygenated blood away from the fetus and one vein carrying oxygenated blood towards the fetus.
    • Amniotic Fluid Function:
      • Cushions: Protects the fetus from injury.
      • Prevents Adhesion: Prevents the fetus from adhering to the amniotic sac.
      • Allows Movement: Provides space for the fetus to move and develop.
    • Embryonic Phase:
      • Begins at implantation and lasts until 8 weeks of gestation.
      • Organogenesis (organ formation) occurs during this phase.
    • Fetal Heart Auscultation:
      • The fetal heartbeat can typically be auscultated between 10-12 weeks of gestation.
    • Fundal Height at 20 Weeks:
      • At 20 weeks of gestation, the fundus (top of the uterus) is usually located at the level of the umbilicus.
    • Term Pregnancy:
      • A full-term pregnancy is considered 39 weeks from the first day of the last menstrual period.

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    Description

    Explore the various physiological changes that occur during pregnancy, including uterine, hormonal, respiratory, renal, and gastrointestinal changes. Understand the impact of hormones like progesterone and estrogen on the body as it adapts to accommodate the developing fetus. This quiz covers critical information relevant to maternal health and pregnancy.

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