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37 Cards in this Set
- Front
- Back
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Placental hormones
HCG |
maintains corpus luteum
basis for pregnancy tests peaks at 12-13wks and plateaus at 20 wks used in early pregnancy to monitor the health of the pregnancy, rises in a predictable fashion with established norms – will double every 2-3 days and correct levels indicate a healthy pregnancy |
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Placental hormones
HPL |
promotes lipolysis in mother
protects fetal glucose supply affects protein metabolism to provide fetus with amino acids antagonist of insulin peripheral insulin resistance results in increased insulin requirements |
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Placental hormones
Progesterone |
produced by the corpus luteum then the placenta
maintains the pregnancy inhibits the contractility of smooth muscle to have both positive and negative effects during pregnancy Positive-relaxes the uterine myometrium to maintain the pregnancy Negative-GI tract, slows peristalsis, constipation, reflux increases aldosterone to promote water retention which aids in blood volume Promotes alveolar development in the breast inhibits prolactin until after delivery decreases sensitivity to oxytocin (oxytocin makes the uterus contract) |
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Placental hormones
Estrogen |
produces hypertrophy and hyperplasia of the uterus
increases uterine blood supply produces breast development relaxes pelvic joints ripens the cervix affects blood composition increase clotting factors promotes sodium and water retention by the kidneys to aid in increasing the blood volume |
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Ovary
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ovulation ceases
corpus luteum persists for about 10 weeks and produces progesterone to maintain the pregnancy |
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Uterus
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Softens and enlarges in a predictable fashion
lower uterine segment softens (Hegar’s sign) out of the pelvis at 12 weeks, at the umbilicus at about 20 weeks grows about 1 cm/week thereafter produces tension on broad and round ligaments Capacity increases from 10ml to 4.5 to 5 liters Braxton Hicks contraction become more frequent and regular in 3rd trimester (q10-20 min) Blood flow increases from 50ml/min at 10 weeks to 500ml/min at term 2nd and 3rd trimester risk of vena cava syndrome |
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Cervix, Vagina, and Outlet
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cervix softens (Goodell’s Sign)
cyanosis of cervix and vagina (Chadwick’s Sign) increased cervical secretions, acidic Yeast infections common in pregnancy mucous plug is formed to obstruct the cervical os as labor approaches the cx softens and effaces |
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Breasts
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number and size of ducts and lobules increase
hypertrophy of the alveoli vascularity increases nipples and areola darken and enlarge colostrum present as early as second trimester |
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Cardiovascular System
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BV increases by about 1500ml
placental perfusion, blood loss at delivery max at 32-34 weeks plasma volume increases 45% (1000ml) RBC volume increases 25-33% (500ml) Iron requirements increased physiological anemia develops CO increases 30-50% heart rate increases 10-15 BPM peripheral resistance decreases 15% BP decreases 5-10 mm Hg second trimester dependent edema due to venous pooling and a fall in plasma proteins Increase in fibrin and fibrinogen creating a hypercoagulable state |
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Respiratory System
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diaphragm rises about 4cm
transverse diameter of the lungs increase by an inch, chest circumference by 2-3 inches Increase in tidal volume of 30-40%% slight increase in respiratory rate decreased maternal CO2 level affinity of maternal Hbg for O2 decreases and the affinity of the fetal hemoglobin for O2 increases Increased vascularity, stuffiness, nose bleeds |
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Renal System
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kidneys and ureters enlarge and dilate
progesterone related blood flow increases 50-80%,GFR (glomular filtration rate) increases by 40-60% caused by increased cardiac output and increased blood volume kidneys function best when woman is side lying creatinine, urea, and uric acid excreted more effectively in pregnancy, so lower on labs glycosuria and proteinuria common and not abnormal UTI are common but often asymptomatic (ASB), second most common problem after anemia |
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Gastrointestinal System
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Mouth
hyperemia of the gums (estrogen) ptyalism Stomach (progesterone) reduced gastric motility and emptying Reflux, pyrosis Intestines (progesterone) decreased motility constipation Gallbladder (progesterone) Delayed emptying, stone formation Nausea and vomiting (HCG and estrogen) Hemorrhoids |
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Musculoskeletal System
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softening and relaxation of many joints
shift in the center of gravity increasing lumbar lordosis |
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Nervous System
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Headaches (blood volume) – only safe medication is Tylenol, make sure the cause isn’t HTN
Dizziness (postural hypotension) Paresthesia (fluid retention) carpal tunnel syndrome from fluid retention around the nerve that supplies the hands |
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Immune System
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Enhancement of the innate immune system
Suppression of the cellular immune system |
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Integumentary System
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Increased blood flow
feel warm, low tolerance to heat Striae gravidarum caused by reduced connective tissue strength and stretching Pigmentation (estrogen, progesterone, melanocyte stimulating horomone) breasts linea nigra chloasma or facial melasma Vascular spiders (estrogen) Palmar erythema (estrogen) Varicose veins |
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Metabolic Changes
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Diabetogenic effects of pregnancy
Progressive requirement for more insulin to overcome the insulin resistance caused by hormones Thyroid gland enlarges, increased BMR by 25% euthyroid state maintained Adrenal increased plasma cortisol levels |
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Prenatal Terminology - NEED TO KNOW
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Gravida
refers to number of pregnancies Para or parity refers to pregnancies carried past 20 weeks Primigravida woman pregnant with her first child Primipara or “primip” woman pregnant with her first child past 20 weeks Multipara or “multip” woman who has carried at least one pregnancy past 20 weeks G_ F or T_ P_ A_ L_ G total number of pregnancies F or T pregnancies carried to 37 weeks P pregnancies carried 20-37 weeks A abortions or miscarriages (before 20 weeks) L living children |
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Signs and Symptoms of Pregnancy
Presumptive (subjective) |
menstrual suppression
nausea and vomiting urinary frequency breast tenderness and enlargement amenorrhea fatigue quickening – fetal movement perceived by the patient |
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Signs and Symptoms of Pregnancy
Probable signs (objective) |
enlarging abdomen
changes in the uterus or cervix Hegar’s sign (softening of LUS) Goodell’s sign (softening of cervix) Chadwick’s sign (bluish coloration of cervix and vagina) Braxton Hicks contractions Ballottement (tap babies head when doing a vaginal exam) positive pregnancy test |
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Signs and Symptoms of Pregnancy
Positive Signs (definite) |
FHT (fetal heart tones)
fetal movements felt by examiner ultrasound |
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Prenatal Care, Initial Visit
Demographics (form p. 318) |
maternal age (35+ at time of delivery is of concern, father at age of 55+), also worry about teenagers due to lifestyle, diet, home environment for the baby, age 15 and under at higher risk for preeclampsia, etc.
race (Jewish – Taysack, white – cystic fibrosis, black – sickle cell, Mediterranean – anemias) religion – due to blood transfusion such as Jehovah’s Witnesses) occupation – health care worker, working with children, any type of teratagen age and medical history of FOB (father of baby) pets (cats - toxoplasmosis, reptiles - salmonella) |
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Prenatal Care, Initial Visit
Genetic screening (form p. 319) to include patient, FOB, family |
Age (35 woman, 50 FOB)
Inherited disorders Mental retardation |
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Prenatal Care, Initial Visit
Family history and Medical History (p 318-319) |
Renal problems including frequent UTI’s
Cardiovascular diseases such as HTN, valvular diseases, DVT or PE Pulmonary issues such as TB and asthma Endocrine diseases such as diabetes and thyroid problems Neurological diseases such as seizure disorders Mental health issues Surgeries, serious injuries GYN disorders STI and other infections ETOH use tobacco street drugs OTC and RX medications Immunizations, flu vaccination domestic violence assessment |
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Prenatal Care, Initial Visit
Obstetrical History |
year
gestational age spontaneous abortions premature type of delivery, anesthesia maternal complications (gestational hypertension,PROM premature rupture of membranes,PTL pre-term labor,GDM gestational diabetes mellitis) birthweight, AGA,SGA,LGA sex condition at birth newborn complications present health, growth and development feeding method |
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Prenatal Care, Initial Visit
History since last period |
medications taken including vitamins
xray exposure exposure to communicable diseases febrile episodes accidents, injuries, illnesses exposure to other potential teratogens |
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Prenatal Care, Initial Visit
Establishing the EDD (expected due date) |
Naegele’s rule – first day date of last period, subtract three months, add one week and add a year (plus or minus two weeks)
Ultrasound – the earlier it is done the more accurate it is, done early for dating then at 15 to 20 weeks for fetal anomalies |
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Prenatal Care, Initial Visit
Vital Signs |
Temperature
Pulse Respirations Blood pressure Weight |
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Prenatal Care, Initial Visit
Physical Examination |
General physical exam
Evaluate breasts for breastfeeding height of the fundus, uterine size FHT 3 sounds Uterine souffle (same as maternal heart beat) Umbilical souffle (same as FHT) FHT |
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Prenatal Care, Initial Visit
Laboratory Evaluation |
blood type and rh (only worry about rh negative, rh positive baby ‘s blood made way into maternal blood the mother’s body would produce antibodies to it and become rh sensitized, RoGHAM would destroy the foreign blood before the mother’s body had a chance to recognize it as foreign) each injection lasts 2 weeks, when the baby is born blood is taken from the cord to see the blood type, if blood is rh negative mother doesn’t need another injection, she gets another injection within 72 hrs after delivery if the baby is positive
antibody screen cbc rubella titer – non-immune will be vaccinated before leaving hospital after delivery syphilis (RPR, STS, VDRL) – must be tested when pregnant by state law sickle cell screen, Hbg electrophoresis hepatitis B surface antigen for chronic carriers HIV – state law to offer testing Urinalysis – primarily for uti’s Pap smear GC culture chlamydia culture – most common sti in US PPD (varies by population) varicella titer (varies by provider) – illness during pregnancies can be lethal for mothers Triple/quad screen depending on gestational age (for NTD and chromosomal abnormalities) -MSAFP, estriol, HCG, inhibin-A usually done at 15-20 weeks Ultrasound (depends on gestational age) TSH (varies by provider) – many children who are mildly retarded had mothers with borderline hypothyroidism Cystic fibrosis testing (expensive) |
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Subsequent labs
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glucose screen at 24-28 weeks on all women, 1hr glucose challenge, under 140 do nothing, done so late to make sure placenta is working really well
Quad screen 15-20 weeks H/H each trimester repeat tests for STD’s (varies by provider) Beta strept culture at 34-36 weeks because it can harm baby in the birth canal, treated with antibiotics during labor if positive to bring down colony count in the mother antibody screen for RH negative at 28 wks Ultrasounds may be repeated |
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Prenatal Care , Return Visits
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Weight
BP urine protein, glucose, ketones (should be none), nitrates (uti’s are dangerous in pregnancy) fetal activity (quickening at 16-20 weeks) fundal height presentation esp after 34 weeks Leopold’s maneuvers FHT (110-160) Assess for problems headache edema – especially above the waist contractions – if before 37 weeks UTI sx discharge, bleeding (never normal in pregnancy and must be evaluated) nausea, vomiting review and schedule labwork education pattern for visits – q4wks until 28 weeks, then every 2 wks until 36 weeks, then every week until 40wks, then twice a week until delivery indications for repeat ultrasounds excessive or inadequate growth previa on first sono ? Presentation after 35 weeks |
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Dietary Guidelines
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300 extra calories/day normal weight woman
mostly protein for amino acids for tissue growth, about 80 grams/day total Guidelines, based on BMI (see Box 11.3, p.305) Underweight 28-40 Normal 25-35 Overweight 15-25 Obese 15 Intervention required Weight loss Failure to gain Excessive weight gain (>6lb/mo or >2lb/week) added risk for preeclampsia 3 meals plus bedtime snack avoid long periods of time without eating plenty of fluids NO sodium restriction prenatal vitamin, 1000mg calcium, 30mg FE., 600 mcg folic acid |
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Dietary Issues
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Morning sickness
Pica – can cause anemia, failure to gain weight Clay, ice, laundry starch most common Vegetarians – mostly worry about B12 and protein New guidelines for fish consumption (p.303) WIC – Women, Infants and Children program, vouchers for healthy foods |
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Anticipatory Guidance
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smoking
alcohol medications (p. 347 has pregnancy risk category, A,B,C,D,X) pets exercise – proportional to what they did before pregnancy travel clothing seat belts Childbirth classes sex saunas and hot tubs – raises body temp, risk of bacteria, dehydration danger signs decreased or absent FM headaches fever, chills leaking fluid bleeding abdominal pain contractions and less than 37 weeks Sudden onset of SOB visual changes edema above the waist UTI sx rashes, sores, exposure to communicable diseases Calf pain |
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Managing Common Discomforts
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urinary frequency
fatigue morning sickness heartburn – all drugs for heart burn are safe for pregnancy constipation – cannot take laxatives, will cause the uterus to contract, must take enemas, castor oil, more fiber, water, exercise, stool softeners, etc. backache edema varicosities headaches |
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Psychosocial Adaptations
Common responses |
Ambivalence (1st)
Introversion (1st, 3rd) Acceptance, joy (2nd) Mood swings (all) Change on body image (2nd,3rd) Impatience (3rd) Maternal Role Tasks (p 308) Ensuring safe passage throughout pregnancy and birth Seeking acceptance of infant by others Seeking acceptance of self in maternal role to infant Learning to give of oneself |
