Signs of Pregnancy Overview

Presumptive Signs of Pregnancy

• Experienced by the patient, not diagnostic.
• Examples include amenorrhea (missed period), nausea, breast tenderness, fatigue, and quickening (fetal movement felt around 18-20 weeks).

Probable Signs of Pregnancy

• Observed by a healthcare provider, but not definitive.
• Examples include a positive pregnancy test (detecting hCG in urine or blood), Chadwick's sign (bluish discoloration of cervix/vagina), Goodell's sign (softening of the cervix), and Hegar's sign (softening of lower uterus).

Positive Signs of Pregnancy

• Confirm pregnancy with certainty.
• Examples include fetal heart tones (detected by Doppler around 10-12 weeks), ultrasound showing fetal parts or cardiac activity, and fetal movements felt by the examiner.

Supine Hypotensive Syndrome (Vena Caval Syndrome)

• Occurs when the enlarged uterus compresses the inferior vena cava in a pregnant woman lying on her back.
• Symptoms include dizziness, nausea, hypotension, and pallor.
• Interventions include encouraging a side-lying position (preferably left), and using a pillow under the hip to elevate the uterus and relieve pressure.

Hormones in Pregnancy

• hCG (Human Chorionic Gonadotropin): Maintains the corpus luteum until the placenta takes over.
• Progesterone: Relaxes smooth muscles to prevent uterine contractions, supports the endometrium for implantation.
• Estrogen: Promotes uterine growth and blood flow, develops breast tissue for lactation.
• Relaxin: Loosens ligaments and joints for delivery.
• Human Placental Lactogen (hPL): Prepares breasts for lactation and regulates glucose availability for the fetus.

Adolescent Pregnancy

• Increased risk of preterm labor, anemia, and hypertension.
• Psychosocial challenges include interrupted education and lack of support.
• Nursing considerations focus on education, prenatal care compliance, nutrition, emotional health, and birth preparation.

Emotional Responses of Pregnancy

• Maternal: First trimester may include ambivalence, excitement, or fear; Second trimester focuses on the fetus and physical changes; Third trimester includes anxiety about labor and delivery.
• Paternal: May experience "Couvade syndrome" (sympathy symptoms like weight gain, nausea). Stages include announcement, adjustment, and focus.

Prenatal Labs, Physiological Changes, and Vaccination

• Common Labs: Blood type and Rh status, Complete Blood Count (CBC), Rubella titer, Hepatitis B and HIV tests, Glucose tolerance test.
• Vaccination Guidelines: Safe vaccines include Tdap and inactivated influenza; Avoid live vaccines (e.g., MMR, Varicella).
• Physiological Changes: Cardiovascular (increased blood volume, decreased BP in second trimester), Respiratory (increased tidal volume, nasal congestion), and Gastrointestinal (heartburn, constipation).

Gravida and Para (TPAL)

• Gravida (G): Total number of pregnancies, including current.
• Para (P): Number of deliveries beyond 20 weeks (living or not).
• TPAL System: T (term births), P (preterm births), A (abortions), L (living children).

Effects of Alcohol, Obesity, Diabetes, and Smoking on the Fetus

• Alcohol: Causes Fetal Alcohol Spectrum Disorders (FASD).
• Obesity: Increases risk of gestational diabetes, macrosomia.
• Smoking: Causes intrauterine growth restriction (IUGR), low birth weight.
• Diabetes: Risk of congenital anomalies, macrosomia, and neonatal hypoglycemia.

Nagele's Rule

• Used to calculate the Estimated Date of Delivery (EDD).
• Formula: Subtract 3 months from the first day of the last menstrual period (LMP), add 7 days, and add 1 year.

Fundal Height Measurement

• Used to assess fetal growth and amniotic fluid volume.
• Technique involves measuring from the pubic symphysis to the top of the fundus.
• Normal findings: Weeks = Fundal height in cm (after 20 weeks).

Maternal Nutrition

• Caloric Needs: No extra calories in first trimester, +340 calories/day in second trimester, +450 calories/day in third trimester.
• Key Nutrients: Folic acid (400-600 mcg/day), Iron, Calcium (for fetal bone development).

Discomforts and Physical Changes During Pregnancy

Childbirth Preparation

• Topics include breathing techniques, stages of labor, and pain management.

Diabetes in Pregnancy

• Screening: Glucose tolerance test at 24-28 weeks.
• Risks: Pre-eclampsia, macrosomia, polyhydramnios.

Molar Pregnancy

• Abnormal growth of trophoblast tissue.
• Requires D&C and follow-up hCG monitoring.

Cerclage (Nursing Care)

• A surgical procedure to stitch the cervix closed to prevent preterm birth or miscarriage.
• Indications: History of second-trimester losses due to cervical insufficiency, painless cervical dilation.
• Nursing care includes monitoring for infections, preterm labor, educating about activity restrictions (e.g., bed rest, pelvic rest), and post-procedure assessments for bleeding or discharge.

Amniocentesis (Reasons for, Results)

• A diagnostic procedure to withdraw amniotic fluid for testing.
• Indications: Detecting chromosomal abnormalities (e.g., Down syndrome), assessing fetal lung maturity, diagnosing infections or other fetal conditions.
• Nursing care includes ensuring informed consent, monitoring maternal and fetal well-being post-procedure, and education on signs of complications (fluid leakage, bleeding, or fever).

Pregnancy at Risk: Ectopic Pregnancy and Miscarriage

• Ectopic Pregnancy: Fertilized egg implants outside the uterine cavity (often fallopian tube). Symptoms include sharp abdominal pain, spotting, and dizziness. Management includes methotrexate if unruptured or surgery if ruptured.
• Miscarriage (Spontaneous Abortion): Pregnancy loss before 20 weeks. Types include threatened, incomplete, complete, and missed. Management involves monitoring hCG levels, and D&C (if incomplete) . Nursing care includes emotional support and monitoring for infection or hemorrhage.

Psychological Adjustment to Pregnancy

• Maternal: First trimester includes ambivalence, excitement, anxiety; Second trimester focuses on attachment to fetus; Third trimester focuses on labor and delivery fears.
• Paternal: Acceptance of pregnancy, shifts in role expectations, possible Couvade syndrome.
• Nursing interventions: Promote open communication, provide education about pregnancy, childbirth, and parenting, and encourage participation in prenatal visits and classes.

This quiz will test your knowledge on the various signs of pregnancy, including presumptive, probable, and positive signs. You'll also learn about supine hypotensive syndrome and its implications during pregnancy. Prepare to explore key concepts that are crucial for understanding pregnancy monitoring.