UNIT 4 EXAM

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Questions and Answers

What is the expected size of the uterus at week 20 of pregnancy?

30 centimeters

20 centimeters (correct)

40 centimeters

10 centimeters

Which sign indicates the softening of the cervix during pregnancy?

Goodell's Sign (correct)

Chadwick's Sign

Hegar's Sign

Braxton Hicks Sign

During pregnancy, which of the following gastrointestinal changes is NOT typically observed?

Constipation

Delayed gastric emptying

Increased dental plaque

Decreased appetite (correct)

What is the typical approach for monitoring fetal well-being between weeks 24-28 of pregnancy?

Glucose load testing Signup and view all the answers

What does the Nagele Rule help establish in prenatal care?

Estimating the delivery date Signup and view all the answers

Which of the following signs during the third trimester indicates potential preeclampsia?

Headache with visual changes Signup and view all the answers

Which pregnancy-related change is NOT associated with the musculoskeletal system?

Improved posture Signup and view all the answers

What is considered a normal weight gain for an overweight woman during pregnancy?

15-25 lbs Signup and view all the answers

Which of the following is a common emotional response during pregnancy?

Acceptance Signup and view all the answers

Which component is NOT part of the Biophysical Profile (BPP) assessment?

Blood sample analysis Signup and view all the answers

Which of the following is considered a presumptive sign of pregnancy?

Fatigue Signup and view all the answers

What physiological change occurs in the uterus after 12 weeks of pregnancy?

It starts growing past the pelvis Signup and view all the answers

Which sign indicates a positive confirmation of pregnancy?

Auscultation of fetal heart tones Signup and view all the answers

What is the purpose of Braxton Hicks contractions?

For practice before actual labor Signup and view all the answers

Which physiological adaptation relates to the pressure exerted on the major blood vessels when the mother lies on her back?

Supine hypotensive syndrome Signup and view all the answers

At what gestational age can fetal movement typically first be felt by the provider?

20 weeks Signup and view all the answers

Which sign occurs as a bluish-purple discoloration of the cervix during early pregnancy?

Chadwick sign Signup and view all the answers

How does the lower portion of the uterus change as pregnancy progresses?

It becomes thinner gradually Signup and view all the answers

Which of the following changes in blood flow capacity occurs as part of uterine adaptations during pregnancy?

Increase in blood flow and capacity Signup and view all the answers

Which sign is associated with softening of the cervix and can be detected around 5 weeks of pregnancy?

Goodell sign Signup and view all the answers

At what gestational week does the Goodell sign, indicating cervical softening, typically begin to be detectable?

5 weeks Signup and view all the answers

Which of the following physiological changes in the uterus is primarily associated with increased blood flow and capacity?

Growth of the uterus past the pelvis Signup and view all the answers

Which physiological change in the cardiovascular system is expected during pregnancy?

Increase in fibrinogen levels Signup and view all the answers

Which sign indicates that fetal heart tones can typically be auscultated?

10-12 weeks Signup and view all the answers

What nutritional recommendation is critical for pregnant women regarding meal frequency?

Eat 3 meals with 1-2 snacks daily Signup and view all the answers

What is the primary purpose of Braxton Hicks contractions during pregnancy?

To practice uterine contractions Signup and view all the answers

What is a key indicator of inadequate fetal well-being that should be monitored by counting fetal movements?

Fetal movements less than 10 per hour Signup and view all the answers

Which of the following signs is typically observable by a healthcare provider between 6-12 weeks of gestation?

Softening of the lower segment of the uterus Signup and view all the answers

Which sign is indicative of gestational diabetes resulting from hormonal resistance during pregnancy?

Glucose intolerance Signup and view all the answers

Which condition may occur if a pregnant mother lies on her back during later stages of pregnancy?

Supine hypotensive syndrome Signup and view all the answers

What anatomical change is commonly seen in the musculoskeletal system during pregnancy?

Lordosis with a protruding abdomen Signup and view all the answers

What effect does increased vascularity have on the vagina during pregnancy?

Lengthening of the vaginal vault occurs Signup and view all the answers

What is the earliest time frame in which a positive pregnancy test can yield a reliable result?

4-6 weeks Signup and view all the answers

Which factor significantly increases the risk of preterm labor during the second trimester?

Presence of regular uterine contractions Signup and view all the answers

What symptom typically manifests as a presumptive sign of pregnancy within 6-12 weeks?

Frequent urination Signup and view all the answers

At what week does Chadwick sign, the bluish-purple discoloration of the cervix, typically occur?

6-8 weeks Signup and view all the answers

What could be a likely consequence of delayed gastric emptying during pregnancy?

Increased nausea Signup and view all the answers

How does the lower portion of the uterus change as pregnancy progresses?

Gradually gets thinner Signup and view all the answers

Which of the following conditions is NOT typically assessed during the first prenatal visit?

Evaluation of fetal heart rate Signup and view all the answers

What is a common psychosocial adaptation experienced by pregnant women?

Consistently heightened ambivalence Signup and view all the answers

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
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
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
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.