NURS-436: Maternal & Child Health (Module 1, Part 1)

What are the three classifications of signs of pregnancy?

Presumptive, probable, and positive signs of pregnancy

What are presumptive signs of pregnancy?

Subjective changes experienced by the woman that suggest pregnancy but do not provide proof of pregnancy

What are common presumptive signs of pregnancy?

Missed menstrual period, nausea and vomiting, breast changes, fatigue, increased urinary frequency, food aversions and cravings, and quickening

What is quickening?

Maternal perception of fetal movement

What are probable signs of pregnancy?

Objective changes that an examiner can detect that suggest pregnancy but are not definitive proof

What pelvic changes may occur as probable signs of pregnancy?

Increased vascular congestion, softening of the cervix, softening of the uterine isthmus, and purple or bluish discoloration of the vaginal walls and cervix

What is Goodell's sign?

Softening of the cervix

What is Hegar's sign?

Softening of the isthmus of the uterus

What is Chadwick's sign?

Purple or bluish discoloration of the vaginal walls and cervix

What are additional probable signs of pregnancy?

Enlargement of the abdomen with continuing amenorrhea, Braxton-Hicks contractions, a positive pregnancy test, and a palpable fetal outline

What specimens are analyzed for clinical pregnancy testing?

Maternal blood or urine

How early can a urine pregnancy test detect pregnancy?

As early as 10 days after conception

When should urine be collected for a home pregnancy test?

Early in the morning

How accurate are urine pregnancy tests?

Approximately 97% to 99% accurate

How early can a blood test detect pregnancy?

As early as 9 days after conception

Which can detect pregnancy earlier, a blood test or urine test?

A blood test, which may detect pregnancy as early as 9 days after conception compared with 10 days for a urine test

What are positive signs of pregnancy?

Definitive and diagnostic indicators that confirm pregnancy

What are two positive signs of pregnancy?

Fetal ultrasound and identification of fetal heart tones via Doppler

Why does the maternal body undergo extraordinary physical changes during pregnancy?

To sustain the pregnancy

What three factors contribute to the physical changes of pregnancy?

Hormonal influences, intrauterine fetal growth, and maternal adaptations to physical changes

How does the position and size of the uterus change as pregnancy progresses?

The uterus enlarges and rises out of the pelvis as pregnancy progresses

Approximately how much blood flow does the term uterus receive?

Approximately 700 mL/min

What cervical change is illustrated by Chadwick's sign?

Bluish discoloration of the cervix

What structure forms within the cervix during pregnancy?

The mucus plug

What ovarian structure is maintained during early pregnancy?

The corpus luteum

What hormone supports the corpus luteum?

hCG

What causes the vaginal changes that occur during pregnancy?

Estrogen-induced changes

How does vaginal vascularization change during pregnancy?

It increases, contributing to Chadwick's sign

How do vaginal secretions change during pregnancy?

They become thicker, white, odorless, and more acidic

What is leukorrhea?

The thicker, white, odorless, and more acidic vaginal secretion associated with pregnancy

What does leukorrhea contribute to during pregnancy?

Formation of the mucus plug

How does the more acidic vaginal environment affect infection?

It helps prevent infection but favors yeast

How does the vaginal wall change by term?

It becomes relaxed to permit distention and passage of the infant

What breast changes are observed during pregnancy?

Increased glandular tissue and development of the alveoli

What structures become more prominent on the areola during pregnancy?

Montgomery's tubercles

What is early breast secretion called?

Colostrum

What upper respiratory changes may occur during pregnancy?

Increased nasal congestion and nosebleeds

How does the chest change during pregnancy?

The size and shape of the chest change

What happens to tidal volume during pregnancy?

Tidal volume increases

Why may respiratory rate increase slightly during pregnancy?

Due to the effects of progesterone, increased tidal volume, and increased oxygen demand

What cardiovascular changes are observed during pregnancy?

Increased blood volume, increased heart rate, decreased blood pressure, and hypercoagulability

What venous condition is a potential consequence of pregnancy-related circulatory changes?

Varicose veins

What causes supine hypotension syndrome during pregnancy?

The gravid uterus compresses the inferior vena cava, decreasing cardiac output and uteroplacental blood flow

What are the symptoms of supine hypotension syndrome?

Hypotension, tachycardia, dizziness, nausea or vomiting, pallor and sweating, and possible syncope

Why does erythrocyte volume increase during pregnancy?

To transport additional oxygen

How does the increase in plasma volume compare with the increase in RBC volume during pregnancy?

Plasma volume increases more than RBC volume, resulting in hemodilution

What is physiologic anemia of pregnancy?

The slightly lower hematocrit that occurs because plasma volume increases more than RBC volume

How is anemia defined during the first and third trimesters?

Hemoglobin less than 11.0 mg/dL or hematocrit of 33%

How is anemia defined during the second trimester?

Hemoglobin less than 10.5 mg/dL or hematocrit of 32%

What hemoglobin level is considered severe anemia during pregnancy?

Hemoglobin less than 6.0 mg/dL

Why does a hypercoagulable state develop during pregnancy?

It is a physiological adaptation that helps prevent postpartum hemorrhage

How much does pregnancy increase the risk for thromboembolic disease?

Approximately 5- to 6-fold

What happens to WBC production during pregnancy?

WBC production increases

How high may the WBC count become during pregnancy?

Up to 30,000/mm³

What is the stated cause of increased WBC production during pregnancy?

The cause is unknown

What gastrointestinal changes are observed during pregnancy?

Nausea or vomiting, heartburn, constipation, and abdominal changes associated with pregnancy

Why can urinary frequency increase during pregnancy?

The pregnant uterus places pressure on the bladder

What urinary tract changes are observed during pregnancy?

Increased urinary frequency, dilation of the urinary tract, and pregnancy-related hydronephrosis

What happens to the renal pelvis and ureters with pregnancy-related hydronephrosis?

They become dilated

What integumentary changes are observed during pregnancy?

Stretch marks, linea nigra, and facial hyperpigmentation

What is linea nigra?

The dark vertical line that may develop along the abdomen during pregnancy

What musculoskeletal changes are observed during pregnancy?

Ligament relaxation, diastasis recti, and postural changes

What is diastasis recti?

Separation of the rectus abdominis muscles

How does posture commonly change as pregnancy progresses?

The enlarging uterus alters maternal posture and spinal curvature

What nervous system-related conditions are depicted during pregnancy?

Carpal tunnel symptoms, sleep-position-related discomfort, and sciatic nerve discomfort

What nerve-related leg discomfort may occur during pregnancy?

Sciatic nerve pain

Which endocrine structures are highlighted as undergoing pregnancy-related changes?

The hypothalamus and pituitary, thyroid, and breasts

What endocrine-related breast process occurs during pregnancy?

Hormonal stimulation of the breasts in preparation for milk production

What history of abuse should be assessed during pregnancy?

History of psychological, sexual, or physical abuse

What emotional problems should be assessed during pregnancy?

Depression, anxiety, and a history of postpartum depression

What should be assessed regarding acceptance of the pregnancy?

Whether the pregnancy was intended or unintended

What birth-related preferences should be assessed prenatally?

The patient's personal preferences about the birth

What postpartum planning should be assessed during pregnancy?

Plans for care of the child following birth

What infant-feeding preferences should be assessed during pregnancy?

Breastfeeding or bottle-feeding preferences

What types of history should be included in a comprehensive pregnancy assessment?

Obstetric, gynecologic and sexual, medical and surgical, psychiatric, family medical, genetic, social, religious and cultural, occupational, complementary and alternative remedy use, substance use, and partner history

What psychiatric history should be assessed during pregnancy?

Conditions such as postpartum depression, major depressive disorder, and bipolar disorder

Whose genetic histories should be considered during pregnancy?

Both parents

What social safety concern should be included in the pregnancy history?

Intimate partner violence

What substances should be assessed during the prenatal history?

Drugs, alcohol, and tobacco

What nontraditional treatments should be assessed during pregnancy?

Complementary and alternative remedies

What does G stand for in GTPAL?

Gravida, or the number of pregnancies including the current pregnancy

What does T stand for in GTPAL?

Term, or the number of pregnancies resulting in a term birth

What does P stand for in GTPAL?

Preterm, or the number of pregnancies resulting in a preterm birth from 20 weeks through 36 weeks and 6 days

What does A stand for in GTPAL?

Abortion, or the number of pregnancies resulting in spontaneous or elective pregnancy loss before 20 weeks

What does L stand for in GTPAL?

Living, or the number of children alive today

What is the GTPAL for a woman who is pregnant for the first time?

G1 T0 P0 A0 L0

What is the GTPAL after her first pregnancy reaches term and the baby lives?

G1 T1 P0 A0 L1

What is the GTPAL when she becomes pregnant a second time?

G2 T1 P0 A0 L1

What is the GTPAL if her second pregnancy ends in miscarriage at 8 weeks?

G2 T1 P0 A1 L1

Does an 8-week miscarriage count as a preterm birth in GTPAL?

No; it counts as an abortion because the pregnancy ended before 20 weeks

What is EDB?

Estimated date of birth

How is Näegele's Rule used to calculate the estimated date of birth?

Subtract 3 months from the LMP and add 7 days

When may Näegele's Rule be inaccurate?

When menses are irregular or absent, cycles are longer than 35 days, or hormonal contraception was used

What is the gold standard for pregnancy dating?

Ultrasound

What ultrasound measurement is used for dating from 6 to 12 weeks?

Crown-rump length (CRL)

How accurate is crown-rump length for dating at 6 to 12 weeks?

Within approximately 3 to 5 days

What ultrasound measurement is used for dating from 14 to 26 weeks?

Biparietal diameter (BPD)

How accurate is biparietal diameter for dating at 14 to 26 weeks?

Within approximately 7 to 14 days

When is fundal height most accurate for estimating gestational age?

Between 18 and 30 weeks

When can the fetal heartbeat first be heard by Doppler?

Approximately 10 to 12 weeks