MATERNITY EXAM #1 STUDY GUIDE ( EXCELLENT STUDY GUIDE )

MATERNITY EXAM #1 STUDY GUIDE PREGNANCY TERMINOLOGY:  Pregnancy o 40 weeks/10 lunar months/280 days  1st 1-13 weeks  2nd14-26 weeks  3rd27-40 weeks  Term = 38-42 weeks  Pre-term = 20-37 weeks, 6/7 days ...

MATERNITY EXAM #1 STUDY GUIDE PREGNANCY TERMINOLOGY:  Pregnancy o 40 weeks/10 lunar months/280 days  1st 1-13 weeks  2nd14-26 weeks  3rd27-40 weeks  Term = 38-42 weeks  Pre-term = 20-37 weeks, 6/7 days  Post-term = 42+ weeks o NAGEL’S RULE (to determine due date)  LMP – 3 months + 7 days & 1 year  OR LMP + 7 + 9 months  Neither are exact, 2 month window on either side “hence why 38- 42 weeks is ‘term’  Sonographic dating helps increase accuracy, especially in women who don’t have normal 28 day cycle o Gravida  Indicates current state of pregnancy/ # of pregnancies experienced  Nulla gravida: never been pregnant  Primi-gravida: 1st pregnancy  Multi-gravida: 2nd or more pregnancy o Para  Description of pregnancy outcome (FT, abortion, miscarriage, labor)  Single number given: pregnancies that have reached viability  4 number system: specific outcomes of ALL pregnancies o Parity: TPAL system  T: # pregnancies that reached term  P: # pregnancies delivered pre-term  A: # pregnancies ended prior to age of viability (~20wks)  Voluntary or spontaneous abortion  L: # living children ANTEPARTUM (PHYSIOLOGY, CARE, NUTRITION) [14 Questions]DETERMINING PREGNANCY:  Presumptive signs/symptoms o Missed period o Breast tenderness o Nausea  Probable signs/ symptoms o Goodell’s sign: softening of the cervix o Chadwic’s sign: bluish-purple discoloration of cervix/uterus o Hegar’s sign: softening of the uterus o + Urine pregnancy test (clinical positive)  Most are 98% accurate; false negatives possible if done too early  Positive signs/ symptoms o Lab confirmation (clinical positive)  Blood test for hCG (human chorionic gonadotropin)  Earliest biochemical marker of pregnancy  Urine pregnancy tests based on recognition of this as early as 4 days after conception  In theory: BEFORE missed period  Uses ELISA marker method  Blood test provides “numerical” analysis of pregnancy  Values increase incrementally with growing pregnancy (how much in blood stream)  Used more often to verify “growth” w/ spotting or risk of “problems” (if number stops rising, something is wrong) o Visualization of fetus o Sonogram/audible heartbeat PHYSIOLOGICAL ADAPTATIONS TO PREGNANCY:  Hormones o Progesterone  Stays high from corpus luteum  Inhibits uterine activity (shedding of lining) o hCG  Increases o Estrogen  Promotes growth of uterine tissues o hPL  Insulin antagonist  Triggers milk production  Makes women at risk for gestational diabetes  To reduce risks: Preconception counseling  Appropriate BMI, diet, etc. o Prostaglandin  Stimulates labor  Uterus o Changes in size, shape, and position w/ growing fetus  At 12wks size of grapefruit and anterior  22-24wks at height of umbilicus  Measured in cm from symphysis pubis: number should correspond to weeks of gestation (24 weeks should = 24cm, 2 cm window on either side) o Uteroplacental blood flow  Increased maternal blood flow to uterus to cross placenta o Cervical changes  Increased vascularitysoftening & blue  Increased vaginal discharge  Ballottment: examiner feels “floating fetus”  Quickening  Maternal perception of fetal movement  ~18 weeksshould continue through pregnancy  May feel like gas, bubbles, etc.  Keep in mind a baby’s sleep cycle is 30-90 minutes and may be why the mother doesn’t feel movement  Lightening  Baby drops down into pelvis (after ~36 weeks)  However…if breeched, won’t really drop  Not all babies drop o Breasts  Fullness, heaviness  Heightened sensitivity (tingling to sharp pain)  Areolae become more pigmented  Montgomery’s tubercles glands/bumps on the areola  Colostrum begins developing by 16 weeks o Cardiovascular  50% increase in blood flow, mostly plasma  Need to be able to send more blood to go to uterus to send O2 & nutrients to the baby  Increased cardiac output  Physiological anemia due to hemodilution (more plasma, not enough blood components)  Increased demand for iron Track CBC in beginning of pregnancy & 3rd trimester  Increased demand for oxygen  Pulse increase in 2nd trimester until term (10-15 bpm higher)  Blood Pressure  Decreased in 2nd tri, return to normal at term  Pressure on vena cava due to gravid uterus; decreased venous return to the heart  Decrease venous return = decreased BP & CO  Also decreased blood to baby  Supine hypotension... lower BP in extremities and baby but higher for mother (short term)  Women advised against sleeping on back o Coagulation  Increased coagulation times= hypercoagulable  At increased risk for DVTs, however most don’t get them o Respiratory  Thoracic breathing  Greater expansion  Pressure from crowded uterus  Increased metabolic rate  Increased demand and consumption of oxygen  Congestion o GI System  N/Vworse in 1st trimester, improves after 12 weeks  Heartburn  Altered metabolism  Changes in carb metabolism, increasing resistance to insulin  Increased risk of gestational diabetes  Delayed gallbladder emptying time  Constipation/hemorrhoids  PICA  Craving non-food substances (paper, clay, dirt)  Not common; alert HCP  Assess for iron deficiency anemia o Renal  Increased GFR due to increased CO  Dilation of ureters/ increased pressure = increased urination  Increased reabsorption of Na+  Some glucose spills at serum levels <160  Report any glucose, protein, ketones in urine to HCP