N303 - Ch 14 Ob

Front 1

What is the goal of maternity care?

Back 1

A healthy pregnancy with a physically safe and emotionally satisfying outcome for the mother, infant, and family

Front 2

What is gravida?

Back 2

A woman who is pregnant

Front 3

What is gravidity?

Back 3

Pregnancy

Front 4

What is multigravida?

Back 4

A woman who has had two or more pregnancies

Front 5

What is multipara?

Back 5

A woman who has completed two or more pregnancies to 20 or more weeks of gestation

Front 6

What is nulligravida?

Back 6

A woman who has never been pregnant

Front 7

What is nullipara?

Back 7

A woman who has not completed a pregnancy with a fetus or fetuses who have reached 20 weeks of gestation

Front 8

What is parity?

Back 8

The number of pregnancies in which the fetus or fetuses have reached 20 weeks of gestation when they are born, not the number of fetuses (e.g. twins) born. Whether the fetus is born alive or stillborn (fetus who shows no signs of life at birth) does not affect parity.

Front 9

What is postdate or postterm?

Back 9

A pregnancy that goes beyond 42 weeks of gestation

Front 10

What is preterm?

Back 10

A pregnancy that has reached 20 weeks of gestation but ends before completion of 37 weeks of gestation

Front 11

What is primigravida?

Back 11

A woman who is pregnant for the first time

Front 12

What is primipara?

Back 12

A woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation

Front 13

What is term?

Back 13

A pregnancy from the beginning of week 38 of gestation to the end of week 42 of gestation

Front 14

What is viability?

Back 14

Capacity to live outside the uterus; about 22 to 25 weeks of gestation

Front 15

What is the earliest biochemical marker for pregnancy?

Back 15

Human chorionic gonadotropin (hCG)

Front 16

When do levels of human chorionic gonadotropin (hCG) peak?

Back 16

At about 60 to 70 days of gestation, then declines until about 80 days of pregnancy

Front 17

What systems can be used to obtain gravidity and parity information?

Back 17

1. Five-Digit (GTPAL) Sytem

2. Two-Digit (G/P) System

Front 18

What is the Five-Digit (GTPAL) Sytem?

Back 18

G = gravidity, number of pregnancies
T = term births
P = preterm births
A = abortions and miscarriages
L = living children

Front 19

What is 1-0-0-0-0 mean using the Five-Digit (GTPAL) Sytem?

Back 19

First pregnancy

Front 20

What is 3-1-1-1-2 using the Five-Digit (GTPAL) System?

Back 20

3 pregnancies, 1 term birth, 1 preterm birth, 1 abortion/miscarriage, and 2 living children

Front 21

What is 2/1 using the Two-Digit (G/P) System?

Back 21

2 pregnancies, 1 viable birth

Front 22

What do higher than normal levels of hCG indicate?

Back 22

Abnormal gestation or multiple gestation

Front 23

What do abnormally lower than normal levels of hCG indicate?

Back 23

Ectopic pregnancy or impending miscarriage

Front 24

What do radioimmunoassay (RIA) pregnancy tests measure?

Back 24

The beta subunit of hCG in serum or urine samples using radioactive labeled markers and are usually performed in a lab

Front 25

When are results of radioimmunoassay (RIA) pregnancy tests available?

Back 25

Within a few hours

Front 26

What is a radioreceptor assay (RRA)?

Back 26

A serum test that measures the ability of a blood sample to inhibit the binding of radiolabeled hCG to receptors. The test is 90% to 95% accurate from 6 to 8 days after conception.

Front 27

What is enzyme-linked immunosorbent assay (ELISA)?

Back 27

The most popular method of testing for pregnancy. It uses a specific monoclonal antibody (anti-hCG) with enzymes to bond with hCG in urine.

Front 28

What is the most common error in performing home pregnancy tests?

Back 28

Performing the test too early in pregnancy

Front 29

What is the basis for most over-the-counter home pregnancy tests?

Back 29

ELISA

Front 30

What do pregnancy tests rely on?

Back 30

Sensitivity and specificity

Front 31

What is sensitivity?

Back 31

Ability to detect low levels of a substance (i.e. hCG)

Front 32

What is specificity?

Back 32

Ability to discern the absence of a substance

Front 33

What assessments are important for the woman's history?

Back 33

1. Date of LMP
2. Usual cycle length
3. Results of previous pregnancy tests
4. Medications

Front 34

What medications may cause false-positive pregnancy results?

Back 34

Anticonvulsants and tranquilizers

Front 35

What medications may cause false-negative pregnancy results?

Back 35

Diuretics and promethazine

Front 36

What errors may cause false results?

Back 36

1. Improper collection of the specimen
2. Hormone-producing tumors
3. Laboratory errors

Front 37

What are the commonly used categories of signs and symptoms of pregnancy?

Back 37

1. Presumptive
2. Probable
3. Positive

Front 38

What are presumptive signs and symptoms?

Back 38

Those changes felt by the woman:

1. Amenorrhea
2. Nausea and vomiting
3. Breast changes

etc...

Front 39

What are probable signs and symptoms?

Back 39

Those changes observed by an examiner:

1. Hegar sign
2. Ballottement
3. Pregnancy tests

etc...

Front 40

What are positive signs and symptoms?

Back 40

Those signs that are attributable only to the presence of the fetus:

1. Hearing fetal heart tones
2. Visualization of the fetus
3. Palpating fetal movements

etc...

Front 41

When does pregnancy begin to "show"?

Back 41

After the 14th week of gestation

Front 42

What is lightening?

Back 42

When the fetus begins to descend and engage in the pelvis

Front 43

What is Hegar sign?

Back 43

Softening and compressibility of the lower uterine segment (the uterine isthmus) occur

Front 44

What is Braxton Hicks contractions?

Back 44

Uterine contractions felt through the abdominal wall soon after the fourth month of pregnancy. These contractions are irregular and painless, and occur intermittently throughout pregnancy.

Front 45

What is the rate of blood flow through the uterus during pregnancy?

Back 45

Averages 500 mL/min

Front 46

What factors are known to decrease uterine blood flow?

Back 46

1. Low maternal arterial pressure
2. Contractions of the uterus
3. Maternal supine position

Front 47

What is used to measure uterine blood flow velocity?

Back 47

Doppler ultrasound

Front 48

When is a Doppler ultrasound examination used?

Back 48

Mostly in pregnancies at risk because of conditions associated with decreased placental perfusion such as HTN, intrauterine growth restriction, DM, and multiple gestation

Front 49

What is the uterine souffle?

Back 49

Sound made by blood in the uterine arteries that is synchronous with the maternal pulse

Front 50

What is the funic souffle?

Back 50

Sound made by blood rushing through the umbilical vessels and synchronous with fetal heart rate

Front 51

What is the Goodell sign?

Back 51

A softening of the cervical tip that may be observed at the beginning of the sixth week in a normal, unscarred cervix

Front 52

What causes the Goodell sign?

Back 52

Increased vascularity, slight hypertrophy. and hyperplasia of the muscle and its collagen-rich connective tissue

Front 53

What is ballottement?

Back 53

Passive movement of the unengaged fetus, which is used to palpate the fetus. The examiner places a finger in the vagina and taps gently upward on the cervix, causing the fetus to rise. The fetus then sinks, and a gentle tap is felt on the finger.

Front 54

When are fetal movements first recognized by the gravida?

Back 54

As early as the 14th to 16th week, but a nulliparous woman may not notice the movements until the 18th week or so

Front 55

What is quickening?

Back 55

Commonly described as aflutter and is difficult to distinguish from peristalsis

Front 56

What is the Chadwick sign?

Back 56

The deepening coloration of the vaginal mucosa and cervix due to increased vascularity (resulting in a violet-bluish color)

Front 57

When is the Chadwick sign observed?

Back 57

Between the 6th and 8th week of pregnancy

Front 58

What is leukorrhea?

Back 58

A white or slightly gray mucoid discharge with a faint musty odor

(normal response to cervical stimulation by estrogen and progesterone)

Front 59

What is the operculum?

Back 59

A mucous plug in the endocervical canal that acts as barrier against bacterial invasion during pregnancy

Front 60

What is the normal pH of vaginal secretions?

Back 60

4 to 7

Front 61

What is the pH of vaginal secretions during pregnancy?

Back 61

About 3.5 to 6 (more acidic than normal)

Front 62

What causes the pH of vaginal secretions to be more acidic during pregnancy?

Back 62

Increased production of lactic acid due to Lactobacillus acidophilus action on glycogen in the vaginal epithelium

Front 63

What is the pregnant woman more vulnerable to?

Back 63

Yeast infections because the glycogen-rich environment is more susceptible to Candida albicans

Front 64

What causes the high degree of sexual interest and arousal during the second trimester of pregnancy?

Back 64

The increased vascularity of the vagina and other pelvic viscera that results in a marked increase in sensitivity

Front 65

What happens to the breasts in response to increased levels of estrogen and progesterone?

Back 65

Fullness, heightened sensitivity, tingling, and heaviness of the breasts occur

Front 66

What causes the enlargement of the breasts during the second and third trimesters of pregnancy?

Back 66

1. Growth of the mammary glands
2. High levels of luteal and placental hormones that promote proliferation of the lactiferous ducts and lobule-alveolar tissue

Front 67

What is felt beneath the breasts upon palpation?

Back 67

Generalized, coarse nodularity

Front 68

What happens to the apical pulse during pregnancy?

Back 68

Shifted upward and laterally about 1 to 1.5 cm, depending on the duration of pregnancy and the size and position of the uterus

Front 69

What changes in the cardiovascular system occur during pregnancy?

Back 69

Changes in the heart size and position and increases in blood volume and cardiac output contribute to audible splitting of S1 and S2, and S3 may be readily heard after 20 weeks of gestation

Front 70

What happens to the pulse during pregnancy?

Back 70

Increases about 10 to 15 BPM

Front 71

How is the cardiac rhythm disturbed during pregnancy?

Back 71

May experience sinus arrhythmia, premature atrial contractions, and premature ventricular systole

Front 72

What factors may increase blood pressure during pregnancy?

Back 72

1. Maternal anxiety
2. Maternal position
3. Size and type of blood pressure apparatus
4. Age
5. Activity level
6. Presence of health problems
7. Circadian rhythm

Front 73

What happens to the diastolic blood pressure during pregnancy?

Back 73

Decreases

(SBP stays the same)

Front 74

What happens to blood volume during pregnancy?

Back 74

Increases by about 1500 mL (or 40% to 45% above nonpregnancy levels)

Front 75

Why does the blood volume increase during pregnancy?

Back 75

Essential for meeting the blood volume needs of the hypertrophied vascular system of the enlarged uterus, for adequately hydrating fetal and maternal tissues and for providing a fluid reserve to compensate for blood loss during birth and puerperium

Front 76

How are the RBCs affected during pregnancy?

Back 76

Increases in mass by about 20% to 30%

Front 77

What is physiologic anemia?

Back 77

The state of hemodilution, in which Hgb decreases (12 to 16g/dl blood) and HCT decreases (37% to 47%)

Front 78

What respiratory conditions are commonly seen during pregnancy?

Back 78

1. Nasal and sinus stuffiness
2. Epistaxis (nosebleed)
3. Changes in the voice
4. Marked inflammatory response that can develop into a mild upper respiratory infection

Front 79

What happens to the acid-base balance?

Back 79

HCO3- decreases, and pH increases slightly

Front 80

What happens to the pH of the urine during pregnancy?

Back 80

The urine contains more nutrients, including glucose, thereby increasing the pH, thus making the urine more alkaline

Front 81

How does the alkaline pH of the urine affect pregnant women?

Back 81

Increases susceptibility to urinary tract infections

Front 82

What blood glucose level would cause glucose to "spill" into the urine?

Back 82

160 to 180 mg/dl

Front 83

What causes hyperpigmentation during pregnancy?

Back 83

The anterior pituitary hormone melanotropin

Front 84

What is chloasma?

Back 84

A blotchy, brownish hyperpigmentation of the skin over the cheeks, nose and forehead, especially in dark-complexioned pregnant women

(also called FACIAL MELASMA or MASK OF PREGNANCY)

Front 85

What is linea nigra?

Back 85

A pigmented line extending from the symphysis pubis to the top of the fundus in the midline

Front 86

What is the linea nigra line referred to as before hormone-induced pigmentation?

Back 86

Linea alba

Front 87

What is striae gravidarum?

Back 87

Stretch marks, which appear in 50% to 90% of pregnant women during the second half of pregnancy

Front 88

What causes morning sickness?

Back 88

Increasing levels of hCG and altered carbohydrate metabolism

Front 89

How is the mouth affected during pregnancy?

Back 89

The gums become hyperemic, spongy, and swollen, causing them to bleed easily due to the increasing levels of estrogen that increases vascularity and connective tissue proliferation (a nonspecific gingivitis)