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56 Cards in this Set

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Abortion
spontaneous or elective termination of pregnancy before 20 weeks gestation. Spontaneous abortion is frequently called miscarriage by lay public.
Amenorrhea
Absence of menstration
Braxton Hicks contractions
irregular, mild uterine contractions that occur throughout pregnance and become stronger in last trimester.
Chadwick's sign
Bluish purple discoloration of cervix, vagina, and labia during prgancy as a result of increased vascular congestion.
Colostrom
breast fluid secreted during pregnancy and the first week after childbirth
diastasis recti
separation of rectus abdominus during pregnancy
Goddell's sign
Softening of cervix during pregnancy
gravida
number of pregnancies, regardless of outcome or duration
hyperemia
excess of blood in a part of the body
melasma
brownish pigmentation of face during pregnancy, also known as "mask of pregnancy"
multigravida
a woman who has been pregnant more than once
nullipara
a woman who has never completed a pregnancy beyond a spontaneous or elective abortion
para
number of pregnancies that have reached 20 or more weeks at delivery, regardless of whether the fetus was born alive or stillborn; refers to # of pregnancies
physiologic anemia of pregnancy
decrease in Hb and Hc values caused by dilution of erythrocytes by expanded plasma volume rather than by an actual decrease in erythrocytes or Hb
postterm birth
birth that occurs after 42 wks gestation
preterm birth
birth that occurs after 20 wks and before the start 38 wks of gestation
primigravida
a woman that is pregnant for the first time
primipara
a woman who has delivered one pregnancy of at least 20 wks
quickening
first movements of the fetus in the uterus felt by the mother
striae gravidarum
irregular pink to purple streaks on abdomen, breasts, or thighs resulting from tears in the connective tissue
term birth
birth that occurs between 38 and 42 weeks gestation
trimester
a division of pregnancy; 1 of 3 equal parts of 13 wks each
Uterine growth - Non pregnant vs. pregnant & 20 wks vs. 36 wks
Non pregnant: 50-70g & 10ml to Pregnant: 800-1200g & 5000ml. Mostly due to hyperplasia and hypertrophy. 20 wks - fundus at umbillicus. 30 wks - fundus at xiphoid process
Uterine contractility
first 2 trimesters - contractions are infrequent. 3rd trimester - more frequent
Uterine Blood Flow during late pregnancy
Increases to 450 - 650mL/min
Cervical changes during pregnancy
estrogen causes cervix to become hyperemic (congested with blood), extend to vagina and labia - Chadwick's sign. Also Goddell's sign - cervical softening
Vaginal and Vulva changes during pregnancy
Vagina - contains increasing amnts of glycogen which causes rapid sloughing and increased discharge also favors growth for yeast infections. Increased pH due to increase lactic acid pdtn
Ovary changes during pregnancy
secretes progesterone for first 6-7wks of pregnancy, until placenta is developed.
Ovulation ceases because...
circulating levels of estrogen and progesterone are high, inhibiting the release of FSH and luteinizing hormone, both necessary for ovulation
Breast changes in pregnancy
highly vascularized, & darker more erect nipples. Presence of colostrum from 12 - 16 weeks in varying amnts. Secretion of milk is suppressed by high levels of estrogen and progesterone.
heart size and position during pregnancy
pushed upward and to the left
Plasma volume changes
increases 1200-1600ml (~40-60%), in order to 1. transport nutrient and oxygen to fetus and 2. meet demands of expanded maternal tissue in uterus and breasts.
RBC Volume changes
Increase in plasma vol. occurs earlier and is greater than increase in RBC vol...sometimes causing physiologic anemia. Increase of 20-30%
Cardiac output changes
increase by 50% due to gain in stroke vol (amount of blood discharged from heart each min.). HR also rises 10-20bpm. CO is highest in lateral position and lowest in supine position.
Peripheral vascular resistance (PVR)
decreases during pregnancy due to 1. smooth m. relaxation from progesterone and prostaglandins 2. addition of uteroplacental unit 3. fetal heat pdtn which may lead to vasodilation 4. decr. reponsiveness to angiotensin 2 receptors 5. Incr. nitric oxide levels that cause vasodilation
Blood pressure
remains stable due to decr. PVR and incr. blood volume.
Supine hypotension
during second half of pregnancy, the weight of uterus partially occludes the vena cava and aorta which impedes blood return from lower extremities, therefore must not lay or sleep supine...instead lateral recumbant position or wedge under hip.
5 major changes in blood flow during pregnancy:
1. blood flow is altered to include uteroplacental unit. 2. ~30% more blood circulates thru kidneys to remove increased metabolic wastes generated by mom and fetus. 3. Incr. circulation to skin to disipate heat produced from incr. metabolism 4. blood flow to breasts increases resulting in engorgement and dilated veins 5. weight of expandin uterus on inferiior vena cava and iliac veins partially obstructs blood return from veins in legs, causing stasis of blood and possible varicose veins.
Leukocyte range
5000-12000 cells/mm3. Up to 15000 cells/mm3. Further increases during labour and early postpartum period
Why is pregnancy a ypercoagulable state?
Incr. in factors that favor coagulation and decr. in factors that inhibit coagulation. Incr. in risk of thrombophlebitis and thrombus formation.
linea nigra
dark line of pigmentation from fundus to symphysis pubis
vascular spider nevi (angiomas)
tiny red elevations that branch in all directions...most often on face, neck, upper chest, arms and legs.
Oxytocin
released by posterior pituitary. Stimulates milk ejection reflex after childbirth and uterine contractions (inhibited by progesterone during pregnancy)
Estrogen
Produced by corpus lutem (initially), then placenta. Functions 1. stim. uterine growth and increases blood supply to uterine vessels 2. aids in developing ductal system in breasts in prep for lactation 3. assoc. with hyperpigemntation, skin vascular changes, incr. activity of salivary glands, and hyperemia of gums
Progesterone
MOST IMPT HORMONE OF PREGNANCY. Intially produced by corpus luteum, then by placenta. Relaxes smooth muscle. 1. Maintains endometrial layer for implantation of fertilized ovum 2. prevents spontaneous abortion by relaxing smooth muscles of uterus 3. prevents tissue rejection of fetus 4. stim. development of lobes/lobules for lactation 5. Facilitates fat deposit for reserve energy 6. raises resp. sensitivity to CO2
Presumptive indicatioins of pregnancy
ammenorhea, nausea vomitting, fatigue, urinary frequency, breast/skin changes, Chadwicks sign, quickennig
probably indications of pregnancy
abdominal enlargement, goddell's sign, ballottment, Braxton Hicks, palpation of fetal outline, uterine souffle (blowing sound auscultated over uterus from blood circ. thru placenta), pregnancy tests (detects human chorionic gonadotropins (hCG)).
Hegar's sign
At 6-8wks, lower uterine segment (isthmus) can be compressed to thinness of paper
Positive indicators of pregnancy
auscultation of fetal heart sounds, fetal movements felt by examiner, visualization of embryo or fetus (ultrasonography at 3-4 wks gestation)
GTPAL
gravida; term births (>_38); preterm births (>20 & <38); abortions (<20); Living children
Estimated due date (EDD) or Estimated date of birth (EDB) or Nagele's rule
add 7 days to first day of last normal menstrual period, subtract 3 months and add a year (if necessary)
For Initial Visit, take a history that includes:
Obstetric Hx (GTPAL, complications, labor experience, length of gestation), Menstrual Hx, Contraceptive Hx, Medical/Surgical Hx, Family Hx, Partner Hx,
Vital Signs for mom:
BP: should be normal, Pulse: 60-90 and take apex for 1 min for murmurs, Resp: 16-24, Temp: 36.6 - 37.6.
Schedule for prenatal assessments:
Conception to 28wk: q 4 wks, 29-36wk: q 2-3 wks, 37wks to birth: weekly
Weight gain average
25-35lb or 11.5-16kg for one fetus. 35-45lb or 16-20.5kg for twins.
Common discomforts of pregnancy
nausea/vomiting, heartburn, backache, varicosities, urinary frequency, hemorrhoids, constipation, leg cramps (imbalance b/t Ca & P, or low Mg)