Podcast
Questions and Answers
What is the expected size of the uterus at week 20 of pregnancy?
What is the expected size of the uterus at week 20 of pregnancy?
Which sign indicates the softening of the cervix during pregnancy?
Which sign indicates the softening of the cervix during pregnancy?
During pregnancy, which of the following gastrointestinal changes is NOT typically observed?
During pregnancy, which of the following gastrointestinal changes is NOT typically observed?
What is the typical approach for monitoring fetal well-being between weeks 24-28 of pregnancy?
What is the typical approach for monitoring fetal well-being between weeks 24-28 of pregnancy?
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What does the Nagele Rule help establish in prenatal care?
What does the Nagele Rule help establish in prenatal care?
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Which of the following signs during the third trimester indicates potential preeclampsia?
Which of the following signs during the third trimester indicates potential preeclampsia?
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Which pregnancy-related change is NOT associated with the musculoskeletal system?
Which pregnancy-related change is NOT associated with the musculoskeletal system?
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What is considered a normal weight gain for an overweight woman during pregnancy?
What is considered a normal weight gain for an overweight woman during pregnancy?
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Which of the following is a common emotional response during pregnancy?
Which of the following is a common emotional response during pregnancy?
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Which component is NOT part of the Biophysical Profile (BPP) assessment?
Which component is NOT part of the Biophysical Profile (BPP) assessment?
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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 physiological change occurs in the uterus after 12 weeks of pregnancy?
What physiological change occurs in the uterus after 12 weeks of pregnancy?
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Which sign indicates a positive confirmation of pregnancy?
Which sign indicates a positive confirmation of pregnancy?
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What is the purpose of Braxton Hicks contractions?
What is the purpose of Braxton Hicks contractions?
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Which physiological adaptation relates to the pressure exerted on the major blood vessels when the mother lies on her back?
Which physiological adaptation relates to the pressure exerted on the major blood vessels when the mother lies on her back?
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At what gestational age can fetal movement typically first be felt by the provider?
At what gestational age can fetal movement typically first be felt by the provider?
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Which sign occurs as a bluish-purple discoloration of the cervix during early pregnancy?
Which sign occurs as a bluish-purple discoloration of the cervix during early pregnancy?
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How does the lower portion of the uterus change as pregnancy progresses?
How does the lower portion of the uterus change as pregnancy progresses?
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Which of the following changes in blood flow capacity occurs as part of uterine adaptations during pregnancy?
Which of the following changes in blood flow capacity occurs as part of uterine adaptations during pregnancy?
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Which sign is associated with softening of the cervix and can be detected around 5 weeks of pregnancy?
Which sign is associated with softening of the cervix and can be detected around 5 weeks of pregnancy?
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At what gestational week does the Goodell sign, indicating cervical softening, typically begin to be detectable?
At what gestational week does the Goodell sign, indicating cervical softening, typically begin to be detectable?
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Which of the following physiological changes in the uterus is primarily associated with increased blood flow and capacity?
Which of the following physiological changes in the uterus is primarily associated with increased blood flow and capacity?
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Which physiological change in the cardiovascular system is expected during pregnancy?
Which physiological change in the cardiovascular system is expected during pregnancy?
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Which sign indicates that fetal heart tones can typically be auscultated?
Which sign indicates that fetal heart tones can typically be auscultated?
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What nutritional recommendation is critical for pregnant women regarding meal frequency?
What nutritional recommendation is critical for pregnant women regarding meal frequency?
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What is the primary purpose of Braxton Hicks contractions during pregnancy?
What is the primary purpose of Braxton Hicks contractions during pregnancy?
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What is a key indicator of inadequate fetal well-being that should be monitored by counting fetal movements?
What is a key indicator of inadequate fetal well-being that should be monitored by counting fetal movements?
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Which of the following signs is typically observable by a healthcare provider between 6-12 weeks of gestation?
Which of the following signs is typically observable by a healthcare provider between 6-12 weeks of gestation?
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Which sign is indicative of gestational diabetes resulting from hormonal resistance during pregnancy?
Which sign is indicative of gestational diabetes resulting from hormonal resistance during pregnancy?
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Which condition may occur if a pregnant mother lies on her back during later stages of pregnancy?
Which condition may occur if a pregnant mother lies on her back during later stages of pregnancy?
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What anatomical change is commonly seen in the musculoskeletal system during pregnancy?
What anatomical change is commonly seen in the musculoskeletal system during pregnancy?
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What effect does increased vascularity have on the vagina during pregnancy?
What effect does increased vascularity have on the vagina during pregnancy?
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What is the earliest time frame in which a positive pregnancy test can yield a reliable result?
What is the earliest time frame in which a positive pregnancy test can yield a reliable result?
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Which factor significantly increases the risk of preterm labor during the second trimester?
Which factor significantly increases the risk of preterm labor during the second trimester?
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What symptom typically manifests as a presumptive sign of pregnancy within 6-12 weeks?
What symptom typically manifests as a presumptive sign of pregnancy within 6-12 weeks?
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At what week does Chadwick sign, the bluish-purple discoloration of the cervix, typically occur?
At what week does Chadwick sign, the bluish-purple discoloration of the cervix, typically occur?
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What could be a likely consequence of delayed gastric emptying during pregnancy?
What could be a likely consequence of delayed gastric emptying during pregnancy?
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How does the lower portion of the uterus change as pregnancy progresses?
How does the lower portion of the uterus change as pregnancy progresses?
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Which of the following conditions is NOT typically assessed during the first prenatal visit?
Which of the following conditions is NOT typically assessed during the first prenatal visit?
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What is a common psychosocial adaptation experienced by pregnant women?
What is a common psychosocial adaptation experienced by pregnant women?
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Study Notes
Presumptive Signs of Pregnancy
- Experienced by the pregnant person
- Fatigue
- Nausea
- Breast tenderness (3-4 weeks)
- Urinary frequency (6-12 weeks)
Probable Signs of Pregnancy
- Detectable by a healthcare provider
- Goodell sign (softening of the cervix) - 5 weeks
- Chadwick Sign (bluish-purple discoloration of cervix) - 6-8 weeks
- Hegar Sign (softening of the lower portion of uterus) 6-12 weeks
- Positive pregnancy test (4-12 weeks)
- Braxton hicks contractions
Positive Signs of Pregnancy
- Ultrasound (4-6 weeks)
- Fetal movement felt by provider (20 weeks)
- Auscultation of fetal heart tones (10-12 weeks)
Physiological Adaptations During Pregnancy
-
Uterus:
- Increased blood flow and capacity
- Grows past the pelvis after 12 weeks
- Lower Uterine Segment:
- Supine Hypotensive syndrome (pressure on vena cava and aorta when mother lays on back)
- Fundal Height Measurement: Week 20 = 20 centimeters, should be level of the umbilicus by week 20
- Braxton Hicks contractions (practice contractions)
- Upper portion of the uterus has changes in circulation/blood flow
- Lower portion of uterus gradually gets thinner
-
Cervix:
- Goodells Sign - softening of cervix
- Chadwicks Sign - bluish-purple color
-
Vagina:
- Vaginal mucosa thickens, connective tissue loosens, vaginal vault lengthens
- Increased/thickening of secretions (whitish vaginal discharge)
- Vascularity increases
-
Breasts:
- Fullness
- Tenderness
- Nipple changes- enlarge and get darker in color
- Colostrum- yellowish discharge (liquid gold)
Gastrointestinal System
- GERD
- Bleeding gums
- Increased Dental plaque and Debris, leading to Gingivitis
- Delayed Gastric Emptying
- Constipation
- Heartburn
Cardiovascular System
- Blood Volume (around 1500 ml increase) - results in anemia due to increased plasma
- Heart rate and blood pressure increase
- Hypercoagulable State: fibrin and fibrinogen levels increase, and see an increase in venous stasis
Respiratory System
- Increased oxygen requirements
- Faster and deeper breathing
Renal/Urinary System
- Dramatic changes related to increased blood volume
Musculoskeletal System:
- Changes in posture and gait
- Stretching joints
- Lordosis (bulging of spine inward)
- Waddle Gait (change of elasticity of joints)
Integumentary System
- Hyperpigmentation (nipples expand and darken)
- Striae Gravidarum (stretch marks)
- Linea Nigra (dark line of pigmentation down the midline of the abdomen)
- Varicosities
Endocrine System
- Growing fetus increased glucose demands
- Insulin does not cross the placenta; fetus supplies its own
- Glucose Intolerance (resistance developed by other hormones later on during pregnancy): prolactin, progesterone and estrogen are thought to oppose insulin (Gestational Diabetes)
Changing Nutritional Needs of Pregnancy
- Consider pre-pregnancy weight
-
Food Concerns:
- Mercury
- Listeriosis
-
Maternal Weight Gain:
- Underweight- 28-40lbs
- Normal weight- 25-35lbs
- Overweight- 15-25lbs
- Obese- 11-20 lbs
-
Special Nutritional Considerations:
- Cultural variations
- Vegetarians
- Pica
Dietary Advice:
- Avoid processed foods
- Limit caffeine
- Avoid diuretics
- DO NOT SKIP MEALS: eat 3 meals a day with 1-2 snacks daily
Psychosocial Adaptations
-
Maternal Emotional Responses:
- Ambivalence
- Acceptance
-
Partner:
- Involve partner in support systems
-
Siblings:
- Prepare siblings for new baby
Preconception and Interconception Care
-
Key areas for focus:
- Immunization status
- Underlying medical status
- Reproductive health data
- Sexuality and sexual practices
- Support systems
- Medications/drug use
- Psychosocial status
- Lifestyle practices
- Nutritional history
First Prenatal Visit
-
Anticipatory Guidance:
- Informing the patient on upcoming visits and tests
-
Comprehensive Health History:
- Age
- Menstrual history
- Prior obstetric history
- Past medical/surgical hx
- Psych/genetic screening
- Nutritional habits
- STD exposure
- Reproductive history (Menstrual History)
-
Nagele Rule:
- First day of last menstrual period, subtract 3 months, add 7 to number of days, adjust year by adding 1 year to determine EDD (Estimated Delivery Date)
-
Reproductive History:
- Obstetric History: Gravida (pregnancy)/para(delivery)
-
Physical Examination:
- Pelvic exam
- Laboratory Tests: - CBC, blood type, rubella titer, Hep B, HIV testing, pap smears, UTI screening, RPR, cultures
OB History:
- G (preganancies)
- P(any delivery over 20 weeks)
- T (Full term deliveries)
- P (preterm deliveries)
- A (abortion- loss of baby under 20 weeks)
- L (living children)
Follow Up Visits
- Every 4 weeks up to 28 weeks
- Every 2 weeks from 29-36 weeks
- Every week from 37 weeks to birth
-
March of Dimes: Prenatal Care Checkups
-
Assessments:
- Weight
- BP
- Urinalysis
- Fetal Growth
- Fetal movement
- Apical HR
-
Assessments:
-
Testing for Gestational Diabetes
- Between 24-28 weeks
- Oral 50g glucose load => 1 hr plasma glucose - >140mg/dl means further testing
-
Testing for Group B Strep
- Between 37-40 weeks
Protein in urine or excessive weight gain towards the end of pregnancy can indicate preeclampsia (affects the kidneys and can cause fluid retention)
Determining Fetal Well Being
-
Fundal Height Measurement
- McDonald Method (20 weeks old= 20 centimeters, week 21= 21 centimeters, ect.)
- Until week 36, typically the largest height of the fundus, baby will drop afterward into the pelvic cavern
- Fetal Movement Determination - Count to 10 Method: Track fetal movements; every time you feel movement, keep track - DANGER SIGN: Absence of fetal movement for >12 hours.
DANGER SIGNS DURING PREGNANCY
-
First Trimester (conception to 12 weeks)
- Spotting or bleeding (miscarriage)
- Painful urination (infection)
- Severe persistent vomiting (hyperemesis gravidarum)
- Fever over 100º (infection)
- Lower abdominal pain with dizziness/Shoulder pain (Ruptured Ectopic Pregnancy)
-
Second Trimester (13 to 28 weeks)
- Regular uterine contractions (preterm labor)
- Pain in calf (DVT)
- Sudden Gush/leakage of fluid from vagina (prelabor ROM- rupture of membranes)
- Absence of fetal movement for >12hrs (fetal distress/demise)
-
Third Trimester (29 to 40 weeks)
- Sudden weight gain
- Periorbital or facial edema
- Severe upper abdominal pain
- Headache with visual changes (gestational HTN, preeclampsia)
- Decrease in fetal movement (fetal destress/demise)
Assessment of Fetal Well being
-
Ultrasonography
- Non-invasive, Non-radiating
- Transabdominal
- Transvaginal
-
Doppler Flow Studies
- Non-invasive
- Examine blood flow in vessels
- Monitor fetal growth, placental function, central venous pressure, cardiac function
-
Marker Screening Tests
- Alpha-fetoprotein Analysis
- Triple Marker Screen
- Quad Screen
- Cell Free DNA
-
Amniocentesis
- Obtain amniotic fluid
- Determine fetal abnormalities
- Examine fetal lung maturity
- Complications possible, informed consent required
-
Chorionic Villus Sampling (CVS)
- Obtain small sample of chorionic villi from developing placenta
- Transabdominal
- Transcervical
- Obtain small sample of chorionic villi from developing placenta
- Nonstress tests (NST) - FHR accelerations: Reactive or non-reactive (Want to see reactive)
- Biophysical profile (BPP) - Five components: Ultrasound and NST - 10 points possible
Childbirth Preparation
-
Perinatal education
- Childbirth education
- Lamaze
- Bradely
- Dick-read
- Childbirth education
-
Review options:
- Birth setting
- Care provider
- Finding choices
- Final preparation for labor and birth
Vulnerable Populations
- Pregnant adolescents
- Women of advanced maternal age
Presumptive Signs of Pregnancy
- Experienced by the patient
- Fatigue
- Nausea
- Breast Tenderness (3-4 weeks)
- Urinary Frequency (6-12 weeks)
Probable Signs of Pregnancy
- Detectable by the provider
- Goodell's sign (softening of the cervix) 5 weeks
- Chadwick's Sign (bluish-purple discoloration of the cervix) 6-8 weeks
- Hegar's Sign (softening of the lower portion of the uterus) 6-12 weeks
- Positive pregnancy test 4-12 weeks
- Braxton Hicks contractions
Positive Signs of Pregnancy
- Ultrasounds (4-6 weeks)
- Fetal movement felt by the provider 20 weeks
- Auscultation of fetal heart tones (10-12 weeks)
Uterine Adaptations During Pregnancy
- Increase in blood flow and capacity
- After 12 weeks, uterus starts growing past the pelvis
- Lower uterine segment gradually gets thinner
- Fundal Height:
- Week 20, uterus should be at the level of the umbilicus (20 centimeters)
- Braxton Hicks contractions
- Supine Hypotensive Syndrome:
- Mother is laying on her back, increases pressure on the vena cava and aorta-
- Can cause dizziness, faintness, etc.
- Uterus puts pressure on the diaphragm, bladder and stomach as baby grows
Cervix Adaptations During Pregnancy
- Goodells Sign - softening of cervix
- Chadwicks Sign - bluish-purple color
Vagina Adaptations During Pregnancy
- Vaginal mucosa thickens, connective tissue loosens, vaginal vault lengthens
- Increased/thickening of secretions (whitish vaginal discharge)
- Vascularity increases
Breast Adaptations During Pregnancy
- Fullness
- Tenderness
- Nipple changes- enlarge and get darker in color
- Colostrum- yellowish discharge (liquid gold)
Gastrointestinal System Adaptations During Pregnancy
- GERD
- Bleeding gums
- Increased dental plaque, debris, and gingivitis
- Delayed Gastric Emptying
- Constipation
- Heartburn
Cardiovascular System Adaptations During Pregnancy
- Blood Volume increases around 1500 ml (expect to see a level of anemia because of the increase in plasma)
- Heart rate and blood pressure increase
- Blood components: (hypercoagulable state) - fibrin and fibrinogen levels increase, and see an increase in venous stasis
Respiratory System Adaptations During Pregnancy
- Increased oxygen requirements
- Individual breathes faster and deeper
Renal/Urinary Adaptations During Pregnancy
- Dramatic changes due to increased blood volume
Musculoskeletal System Adaptations During Pregnancy
- Changes in posture and gait
- Stretching joints
- Lordosis (bulging of spine inward)
- Waddle Gait (change of elasticity of joints)
Integumentary System Adaptations During Pregnancy
- Hyperpigmentation (nipples expand and darken)
- Striae Gravidarum (stretch marks)
- Linea Nigra (dark line of pigmentation down the midline of the abdomen)
- Varicosities
Endocrine System Adaptations During Pregnancy
-
Pancreas:
- Growing fetus has growing glucose demands
- Insulin does not cross the placenta; fetus supplies its own
- Glucose intolerance (resistance developed by other hormones later on during pregnancy) prolactin, progesterone and estrogen are thought to oppose insulin (Gestational Diabetes)
Changing Nutritional Needs of Pregnancy
- Consider pre-pregnancy weight
- Food concerns:
- Mercury
- Listeriosis
Maternal Weight Gain
- Steady weight gain week by week
- Underweight- 28-40 lbs
- Normal weight- 25-35 lbs
- Overweight- 15-25 lbs
- Obese- 11-20 lbs
Special Nutritional Considerations
- Cultural variations
- Vegetarians
- Pica
Nutritional Recommendations
- Avoid processed foods
- Limit caffeine
- Avoid diuretics
- DO NOT SKIP MEALS, eat 3 meals a day with 1-2 snacks daily
Psychosocial Adaptations
- Maternal Emotional Responses
- Ambivalence
- Acceptance
- Partner
- Siblings
Preconception and Interconception Care
- Key areas for focus:
- Immunization status
- Underlying medical status
- Reproductive health data
- Sexuality and sexual practices
- Support systems
- Medications/drug use
- Psychosocial status
- Lifestyle practices
- Nutritional history
First Prenatal Visit
- Anticipatory guidance
- Comprehensive Health history
- Age
- Menstrual history
- Prior obstetric history
- Past medical/surgical history
- Psych/genetic screening
- Nutritional habits
- STD exposure
- Reproductive history (Menstrual History)
Nagele's Rule
- First day of first menstrual period, subtract 3 months, add 7 days, adjust year by adding 1 year to determine EDD (Estimate Delivery Date)
Reproductive History
- Gravida (pregnancy)/para(delivery)
Physical Examination
- Pelvic exam
Laboratory tests
- CBC
- Blood type
- Rubella titer
- Hep B
- HIV testing
- Pap smears
- UTI screening: RPR, cultures
-
GTPAL
- G (preganancies)
- P(any delivery over 20 weeks)
- T (Full term deliveries)
- P (preterm deliveries)
- A (abortion- loss of baby under 20 weeks)
- L (living children)
Follow Up Visits
- Every 4 weeks up to 28 weeks
- Every 2 weeks from 29-36 weeks
- Every week from 37 weeks to birth
March of Dimes: Prenatal Care Checkups
- Assessments
- Weight
- BP
- Urinalysis
- Fetal Growth
- Fetal movement
- Apical HR
Testing for Gestational Diabetes
- Between 24-28 weeks
- Oral 50g glucose load => 1 hr plasma glucose
-
140mg/dl means further testing
-
Testing for Group B Strep
- Between 37-40 weeks
Protein in urine or excessive weight gain towards the end of pregnancy
- Can indicate preeclampsia (affects the kidneys and can cause fluid retention)
Determining Fetal Well Being
- Fundal Height Measurement
- McDonald Method (20 weeks old= 20 centimeters, week 21= 21 centimeters, etc.)
- Until week 36, typically the largest height of the fundus, babys will drop afterward into the pelvic cavern
Fetal Movement Determination
- Count to 10 method - every time you feel the baby move, keep tracking movements
DANGER SIGNS DURING PREGNANCY
First Trimester (conception to 12 weeks)
- Spotting or bleeding (miscarriage)
- Painful urination (infection)
- Severe peristent vomiting (hyperemesis gravidarum)
- Fever over 100º (infection)
- Lower abdominal pain with dizziness/Shoulder pain (Ruptured Ectopic Pregnancy)
Second Trimester (13 to 28 weeks)
- Regular uterine contractions (preterm labor)
- Pain in calf (DVT)
- Sudden Gush/leakage of fluid from vagina (prelabor ROM- rupture of membranes)
- Absence of fetal movement for >12hrs (fetal distress/demise)
Third Trimester (29 to 40 weeks)
- Sudden weight gain
- Periorbital or facial edema
- Severe upper abdominal pain
- Headache with visual changes (gestational HTN, preeclampsia)
- Decrease in fetal movement (fetal distress/demise)
Assessment of Fetal Well Being
Ultrasonography
- Non invasive
- Non radiating
- Transabdominal
- Transvaginal
Doppler Flow Studies
- Non-invasive
- Examine blood flow in vessels
- Monitor fetal growth, placental function, central venous pressure, cardiac function
Marker Screening Tests
- Alpha-fetoprotein Analysis
- Triple Marker Screen
- Quad Screen
- Cell Free DNA
Amniocentesis
- Obtain amniotic fluid
- Fetal abnormalities
- Fetal lung maturity
- Ultrasound
- Complications
Chorionic Villus Sampling
- Obtain small sample of chorionic villi from the developing placenta
- Transabdominal
- Transcervical
- Significant risks => informed consent
Nonstress tests
- FHR accelerations
- Reactive or non reactive (Want to see reactive)
Biophysical profile (BPP)
- Five components
- Ultrasound
- NST
- 10 points possible
Childbirth Preparation
- Perinatal education
- Childbirth education
- Lamaze
- Bradely
- Dick-read
- Review options
- Birth setting
- Care provider
- Finding choices
- Final preparation for labor and birth
Vulnerable populations
- Pregnant adolescents
- Woman of advanced maternal age
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Description
This quiz covers the signs of pregnancy including presumptive, probable, and positive signs, as well as the physiological adaptations that occur during pregnancy. Test your knowledge on how these signs and changes manifest throughout the trimesters and their implications for maternal health.
