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Questions and Answers
Which of the following is NOT a presumptive sign of pregnancy?
At what gestational age does uterine enlargement begin to be noticeable above the symphysis pubis?
Which sign indicates a positive confirmation of pregnancy?
What changes occur to the cervix during pregnancy?
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What is the typical fetal heart rate range during pregnancy?
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Which of the following is a probable sign of pregnancy?
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When does quickening typically occur for first-time mothers?
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Which of the following signs is indicative of Braxton Hicks contractions?
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What is the primary function of the placenta in fetal circulation?
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Which vessel in the umbilical cord carries oxygenated blood to the fetus?
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What is the role of the ductus arteriosus in fetal circulation?
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Where does the highly oxygenated blood from the right atrium go in fetal circulation?
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What happens to the ductus venosus after birth?
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Which statement distinguishes fetal circulation from adult circulation?
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What role does the foramen ovale play in fetal circulation?
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Which of the following describes the pathway of blood from the placenta to the fetus?
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What is the primary reason for the formation of the operculum plug during pregnancy?
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Which sign indicates cervical softening probably due to hormonal changes in early pregnancy?
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What condition is characterized by persistent vomiting beyond typical morning sickness?
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What is one of the recommended interventions for alleviating constipation during pregnancy?
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Which skin condition manifests as brown pigmentation in areas such as the nose and cheeks during pregnancy?
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What is an important component of prenatal care aimed at ensuring the health of the mother and newborn?
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Which symptom is typically associated with decreased gastric motility during pregnancy?
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Which of the following is NOT a typical recommendation for managing heartburn during pregnancy?
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What does 'G' represent in the history of past pregnancy?
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Which fetal heart tone range is considered normal?
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Naegele's Rule is used to calculate which of the following?
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According to Bartholomew's Rule, where is the fundus located at 24 weeks gestation?
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In Johnson’s Rule, what does 'K' represent?
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When performing Leopold’s Maneuver, what is the first action to instruct the mother?
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What does the Umbilical Grip help to assess?
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Which fundal height measurement indicates the fetus is at the level of the xiphoid process?
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Study Notes
Fetal Circulation
- Fetal circulation differs significantly from adult circulation.
- The placenta acts as the fetus's lungs, providing oxygen and nutrients.
- The umbilical cord contains two arteries carrying deoxygenated blood and one vein carrying oxygenated blood. This is the opposite of adult circulation.
- Three shunts—ductus arteriosus, ductus venosus, and foramen ovale—redirect blood flow, bypassing the lungs.
- These shunts close after birth.
Fetal Circulation Shunts
- Ductus Arteriosus: Protects lungs from circulatory overload; strengthens the right ventricle; directs most oxygenated blood away from the lungs.
- Ductus Venosus: Connects umbilical vein to inferior vena cava; carries mostly oxygenated blood; flow regulated by a sphincter.
- Foramen Ovale: Shunts highly oxygenated blood from right atrium to left atrium.
Fetal Heart Chambers and Blood Flow
- Blood flows from the placenta via the umbilical vein.
- Blood may bypass the liver via the ductus venosus or flow through the liver.
- Blood enters the inferior vena cava, then the right atrium.
- From the right atrium, blood may pass through the foramen ovale to the left atrium, or through the tricuspid valve to the right ventricle.
- Blood from the right ventricle flows to the lungs via the pulmonary artery or passes through the ductus arteriosus to the aorta.
- Oxygenated blood from the lungs returns to the left atrium via the pulmonary veins.
- Oxygenated blood from the left atrium goes to the left ventricle and then the aorta for systemic circulation.
- Deoxygenated blood returns to the placenta via the umbilical arteries.
Signs of Pregnancy
- Presumptive Signs: Subjective signs experienced by the mother (morning sickness, amenorrhea, skin changes, fatigue, urinary frequency, quickening).
- Probable Signs: Objective signs observed by the examiner (Chadwick's sign, Hegar's sign, uterine enlargement, positive pregnancy test, ballottement, outlining of the fetus, Goodell's sign, Braxton Hicks contractions).
- Positive Signs: Confirm the presence of a fetus (fetal heart tone, fetal movement felt by examiner, visualization of the fetus).
Physiological Adaptations of Pregnancy
- Uterus: Enlarges significantly throughout pregnancy, reaching the xiphoid process around 36 weeks and then descending slightly before delivery (lightening).
- Cervix: Undergoes changes including color change (pink to purplish), increased mucus production (leukorrhea), formation of the operculum, softening (Goodell's sign), and softening of the lower uterine segment (Hegar's sign). Chadwick's sign also appears.
- Gastrointestinal System: Morning sickness (nausea and vomiting), hyperemesis gravidarum (persistent vomiting), constipation, heartburn (pyrosis).
- Integumentary System: Striae gravidarum (stretch marks), chloasma/melasma (mask of pregnancy), linea nigra.
- Endocrine System: Slight thyroid enlargement.
- Skeletal System: Lordosis (swayback), waddling gait, leg cramps.
Prenatal Care
- Comprehensive medical care during pregnancy.
- Includes history taking, physical examination, disease treatment, immunizations, supplementation, health education, and laboratory examinations.
Obstetric History
- Gravida (number of pregnancies).
- Para (number of pregnancies reaching viability).
- Term (number of full-term deliveries).
- Preterm (number of preterm deliveries).
- Abortions (number of spontaneous or induced abortions).
Assessment of Fetal Growth
- Fetal heart tone (120-160 bpm).
- Fetal movement (quickening generally starting around 28 weeks, 10 movements per day as a guideline).
Estimating Gestational Age and Fetal Weight
- Naegele's Rule: Estimates expected delivery date (EDD) from the last menstrual period (LMP).
- McDonald's Rule: Estimates gestational age from fundal height.
- Bartholomew's Rule: Estimates gestational age based on the location of the fundus.
- Johnson's Rule: Estimates fetal weight based on fundal height and engagement.
Leopold's Maneuvers
- A systematic method of abdominal palpation to determine fetal presentation, lie, position, and engagemen.
- Four steps: fundal grip, umbilical grip, Pawlik's grip, pelvic grip.
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