Antepartum

Front 1

Presumptive Signs of Pregnancy

Back 1

*Presumptive signs are changes noticed by the woman
Breast changes (3-4 wk)
Amenorrhea (4 wk)
Nausea, vomiting (4-14 wk)
Urinary frequency (6-12 wk)
Fatigue (12 wk)
Quickening (16-20 wk)

Front 2

Probable Signs of Pregnancy

Back 2

*Probable signs are changes observed by an examiner
Goodell sign (5 wk)
Chadwick sign (6-8 wk)
Hegar sign (6-12 wk)
+ pregnancy test (4-12 wk)
Braxton Hicks contractions (16 wk)
Ballottement (16-28 wk)

Front 3

Positive Signs of Pregnancy

Back 3

*Positive signs are attributable only to the presence of the fetus
Visualization of fetus by ultrasound (5-6wk)
Fetal heart tones detectable by ultrasound (6 wk)
Fetal movements palpated (19-22 wk)
Fetal movements visible (late pregnancy)

Front 4

Hegar sign

Back 4

Softening and compressibility of the lower uterine segment (isthmus) this is classified as a probable sign of pregnancy and that may be present during the 2nd and 3rd months of pregnancy and is palpated during bimanual examination

Front 5

Braxton Hicks contractions

Back 5

Contractions that begin soon after the fourth month and are most definite after 28 wk. They do not increase in intensity or frequency or cause cervical dilation like labor contractions. These contractions facilitate uterine blood flow through the intervillous spaces of the placenta and thereby promote oxygen delivery to the fetus. These contraction are not painful and usually cease with walking or exercise.

Front 6

Goodell sign

Back 6

A softening of the cervical tip that can be observed at approx. 6 wk in a normal, unscarred cervix. (p. 293)

Front 7

Ballottement

Back 7

Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. In the technique used to palpate the fetus, the examiner places a finger in the vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and a gentle tap is felt on the finger. (fig. 13-6, p. 295)

Front 8

Quickening

Back 8

The first recognition of fetal movements by the mother, commonly described as a flutter and is difficult to distinguish from peristalsis. The multiparous mother recognizes these movements as early as 14-16 wk, where the nulliparous mother may not recognize these movements until the 18th wk or later. (p. 294)

Front 9

Chadwick sign

Back 9

The violet-bluish color of the vaginal mucosa and cervix noticeable at 6-8wk . This deepened color is due to increased vascularity. (p.295)

Front 10

Leukorrhea

Back 10

The normal white or slightly grey mucoid discharge that occurs in response to cervical stimulation by estrogen and progesterone. A faint musty odor is normal. The discharge should never be pruritic or blood stained, nor should it have a foul smelling odor. (p. 295)

Front 11

Operculum

Back 11

The mucous plug that fills the endocervical canal. It acts as a barrier against bacterial invasion during pregnancy.

Front 12

pH of vaginal secretions during pregnancy

Back 12

The pH of vaginal secretions is more acidic than normal due to an increased production of lactic acid. This acidic environment provides protection from some organisms, but leaves the woman more vulnerable to yeast infections (Candida albicans). (p. 295)

Front 13

Breasts
(Physiologic Changes)

Back 13

Fullness, heightened sensitivity, tingling (mild to sharp pain), and heaviness occur in the first trimester.

Nipples and areolae become more pigmented, secondary pinkish areolae develop, and nipples become more erectile.

Hypertrophy of Montgomery tubercles (oil glands seen around nipples)

Blood vessels become more visible and striae gravidarum may appear

During the 2nd and 3rd trimesters breasts have a coarse nodularity when palpated

Colostrum may be expressed from nipples as early as 16 wk (creamy white-to-yellowish-to-orange fluid)

Front 14

Breast Discomfort
(Education for Self-Management)

Back 14

Wear supportive maternity bras with pads to absorb discharge, may be worn at night.

Wash with warm water and keep dry.

Breast tenderness may interfere with sexual expression but is temporary.

Front 15

Cardiovascular System
(Physiologic Changes)
1 of 2

Back 15

Heart rate increases 10-15 beats/min
Diastolic BP: slight decrease to 24-32 weeks, gradually returns to prepregnancy BP by end of preganancy
Blood volume increases by 1500 ml or 40%-50% above prepregnancy level
RBC mass increases by 18%
Hgb and Hct decrease
*A Hgb that drops below 11 g/dl should be considered abnormal and is often due to iron def. anemia. Hct should be >33
WBC count increases during 2nd trimester, peaks during 3rd. Normal WBC count during pregnancy 5,000-15,000
Circulation time decreases slightly by week 32.
There is an increase in clotting factors and a decrease in fibrinolytic activity making the woman more vulnerable to thrombosis esp. after c-section.

Front 16

Cardiovascular System
(Physiologic Changes)
2 of 2

Back 16

Cardiac output increases 30%-50% (caused by an increase in stroke volume and HR that occur in response to increased tissue demands for oxygen)

During the second half of pregnancy, supine hypotensive syndrome may occur when a woman lies flat on her back due to compression of the vena cava. Systolic BP may drop more than 30 mm Hg, a reflex bradycardia may occur, cardiac output is reduced by half, and the woman may feel faint.

Dependent edema, varicose veins in the legs and vulva, and hemorrhoids are caused by compression of the iliac venis and inferior vena cava by the uterus.
*The lateral recumbent position does not cause compression and increases cardiac output

Front 17

Respiratory System
(Physiologic Changes)
1 of 2

Back 17

Ligaments of the ribcage relax, permitting increased chest expansion, ribcage increases in size and may not return to prepregnancy state.
Diaphragm is displaced-thoracic breathing replaces abdominal breathing
Increased vascularity of UR tract-nasal and sinus stuffiness, epistaxis (nosebleed), changes in voice, mild URIs, earaches.
Basal metabolic rate increases-peripheral vasodilation, increased sweating, heat intolerance, lassitude, and fatigue

Front 18

Respiratory System
(Physiologic Changes)
2 of 2

Back 18

Tidal volume increased 30%-40%
Inspiratory capacity increased
Expiratory volume decreased
Oxygen consumption increased 20%-40%
RR unchanged to slightly increased
Vital capacity unchanged
Total lung capacity unchanged to slightly decreased

Front 19

Acid-Base Balance

Back 19

Pregnancy is a state of compensatory respiratory alkalosis: Increased sensitivity to CO2, decreased Pco2 (-5 mm Hg by 10th week), bicarbonate decreased, pH increased slightly, and tidal volume is increased. This facilitates the transport of CO2 from the fetus and the release of O2 from the mother to fetus.

Front 20

Renal System
(Anatomic Changes)

Back 20

Renal pelves and ureters dilate (more so on right side)
Ureters elongate
-These changes cause altered clearance tests and stagnation of urine which can lead to UTIs.
Bladder capacity increases to 1500 ml, but compression from the growing uterus results in frequent voiding of small amounts.

Front 21

Renal System
(Functional Changes)

Back 21

Glomerular filtration (GFR) and renal plasma flow (RPF) increase.
*A side lying position increases renal perfusion (+urinary output, -edema)
Renal tubular reabsorption of Na+ increases
+ water excretion early in pregnancy leads to + thirst (water excretion not as effective later in pregnancy=dependent edema)
Glucosuria can occur when BG <160
Proteinuria common, however w/HTN the woman must be closely monitored.

Front 22

Integumentary System
(Physiologic Changes)

Back 22

Hyperpigmentation stimulated by the anterior pituitary hormone melanotropin.
Angiomas (vascular spiders) found on neck, thorax, face, and arms appear 2-5 months and disappear after birth.
Mild pruritus normal and resolves in postpartum period.
Gum hypertrophy may occur.
Nails may grow faster and become thinner/softer.
Oily skin and acne may occur or skin may become clear and radiant.
Fine hair growth will disappear after pregnancy while coarse or bristly hair growth will not.
Scalp hair loss slows during pregnancy and may increase postpartum.
Perspiration increases.

Front 23

Chloasma

Back 23

"Mask of pregnancy"
Blotchy, brownish hyperpigmentation of the cheeks, nose, and forehead, especially in dark-complexioned pregnant women.
Occurs in 50%-70% of pregnant women.
Begins after 16 wk and gradually increases.
The sun intensifies the pigmentation.
Usually fades after birth.

Front 24

Linea Nigra

Back 24

Pigmented line extending from the symphysis pubis to the top of the fundus in the mid-line.
Begins in the third month for primigravidas extending with height of fundus.
Entire line often appears before 3 months in multigravidas.
Sometimes it is just a line of hair growth noticed or no line at all.

Front 25

Striae Gravidarum

Back 25

Stretch marks
Appear in 50%-90% of women during 2nd half of pregnancy, may be caused by increased adrenocorticosteriods.
Abdomen, thighs, and breasts
May cause itching sensation
Familial tendency
Will fade after pregnancy but never completely go away.

Front 26

Palmar Erythema

Back 26

Pinkish-red blotches over the palmar surfaces of hands in ~60% of Caucasian and 35% African-American women.
Primarily due to increased estrogen.

Front 27

Epulis

Back 27

Red, raised nodule on the gums that bleeds easily.
May develop ~third month and continues to enlarge as pregnancy progresses.
Managed by avoiding trauma to gums (using soft toothbrush)
Spontaneously regresses after birth.