Week 1- Reproduction and antepartum

Exam 1

First trimester

Weeks 1-13.

Second trimester

Weeks 14-26.

Third trimester

Weeks 27-40+.

Gravida

The number of times a woman has been pregnant.

Primigravida

A woman pregnant for the first time. After she delivers it is called primipara.

Multigravida

A pregnant woman who has previously carried a fetus to the point of viability.

Para

The number of births that reached a viable gestational age.

GTPAL

G= Gravida; number of pregnancies

T= Term; number of term pregnancies (37-42 weeks)

P= Preterm; number of preterm pregnancies (20-37 weeks)

A= Abortions/miscarriages; number of induced or spontaneous abortions

L= Live; number of living children.

Antepartum

Period of pregnancy between conception and labor.

Intrapartum

Labor/delivery- period of pregnancy from the onset of labor through delivery of the placenta.

Postpartum

From delivery of placenta to.a period after childbirth (at least 6 weeks) during which progressive physiologic changes restore uterus size back to normal and system functions back to a non-pregnant status.

Presumptive signs

• 3-4 weeks: breast changes/amenorrhea

• 4-14 weeks: N/V, urinary frequency, fatigue (12 weeks)

• 16-20 weeks: quickening

Probable signs

• 5-8 weeks: Goodell and Chadwick sign

• 4-12 weeks: positive pregnancy test serum/urine, hegar sign

• 16-28 weeks: Braxton Hicks contractions and ballottement

Positive signs

• 5-6 weeks: ultrasound verification of fetus and possibly heart tones

• 16 weeks: visualization of fetus by radiographic study (ultrasound)

• 8-17 weeks: heart tones detectable by doppler

• 19-22 weeks: fetal movements detected by examiner

• Late pregnancy: fetal movement visible.

Naegele’s rule

• Determine first day of LMP

• Subtract 3 calendar months and add 7 days

Rh incompatibility

Mother is Rh- and father is Rh+. Mother can develop antibodies against the D antigen on the real RBC.

Fetal outcomes: course lysis of fetal RBC, hyperbilirubinemia, and kernicterus.

Rh immune globulin given IM to mother at 28 weeks gestation and 72 hrs postpartum if indicated to suppress immune response. Given after a miscarriage.

Prenatal visits

• Monthly: 8-28 weeks

• Every 2 weeks: 28-36 weeks

• Every week: 36-term

• Each visit check: vital sings, weight, urine- protein, glucose, nitrates, fundal height, contraction assessment, vaginal bleeding assessment, amniotic fluid assessment, infections/exposures.

Fetal movement

• During 3rd trimester, the fetus makes about 30 gross movements/hour- the woman may detect 70-80% of these.

• Daily kick counts after 30 weeks of gestation: should have 10 movements in a 2 hours period.

• Red flags- fewer than 10 movements in 3 hours, longer each day to get 10 movements, no fetal movement in the morning, not fetal movement in 12 hours, and less activity as the pregnancy progresses.

Amniocentesis

Important medical procedure for high-risk pregnancies to determine a variety of disorders, such as genetic problems, congenital malformation, metabolic dysfunctions, Rh blood type incompatibility. Risks include fetal injury, leakage of amniotic fluid, contractions/labor.

Weight gain

Amount of weight gained by term. Represents a baby, amniotic fluid, placenta, increase in uterine size, blood volume, extravascular fluid, maternal fat, and breasts. Weight gain reflects both mother and fetus; approximately 62% water gain, 30% fat gain, and 8% protein gain.

Physical changes in first trimester

• Uterus becomes a globular shape, softens, and flexes easily over cervix. This causes compression of bladder, which results in urinary frequency. Increased vascularity, congestion, and edema cause cervix to soften and become bluish purple.

• 7th week- BP begins to drop until mid-pregnancy due to decreased peripheral vascular resistance. Systemic vascular resistance decreases from vasodilator effect of progesterone and prostaglandins.

• 9th week- embryonic period ends and fetal period begins, at which time major structures are present. FHTs can be heard by doppler US between 9 and 12 weeks.

• 12 week- uterus may me palpated. Placental is formed, yolk sac is not needed anymore.

12 weeks

Location at pubic symphysis

Weeks 20-22

Location at umbilicus.

38 weeks

Location at xiphoid.

Physical changes in second trimester

• Weeks 12-16: nausea, vomiting, fatigue, and urinary frequency of first trimester improve.

• Weeks 16-20: woman recognizes fetal movements. As breast enlargement continues, the veins of breast enlarge and are more visible through skin of lightly pigmented women. Colostrum, precursor of milk, may be expressed through nipples.

• Estrogen and progesterone have a melanocyte-stimulating effect and melanocyte-stimulating hormone levels escalate

• Striae gravidarum on breast, abdomen, and areas of weight gain.

• Systolic BP may be 2 to 8 mm Hg lower and diastolic BP 5 to 15 mm Hg lower than pre-pregnancy levels.

• Stomach and intestinal displacement

• Gastric reflux- increase in progesterone causes relaxed esophageal sphincter/gastric tone

• Constipation- can lead to hemorrhoids

• Gallbladder malfunction- progesterone relaxes smooth muscle, empties sluggishly and may become distended

• Blood volume increases rapidly.

Colostrum

Yellow in color, more minerals and protein but less sugar and fat than mature milk. Contains antibodies: protection for newborn during its first days of life until mature milk production begins.

Linea nigra

Midline of abdominal skin becomes pigmented.

Physical changes in third trimester

• Blood volume increases- peaks and plateaus in middle of third trimester. Erythrocyte mass increases by 20-30%, caused by an increase in erythropoiesis. Plasma volume increases slightly more, causing slight hemodilution and small drop in hematocrit. BP slowly rises again to approximately prepregnant level. Systolic murmur can be heard in more than 95% of pregnant women.

• Diaphragm rises due to uterine enlargement- widening rib cage, decreased spaced for lung expansion; SOB. Displaces heart up and to the left- cardiac output, stroke volume, and force of contraction ar increased. Pulse rate rises 15 to 20 bpm.

• Compromised venous return- due to enlarged uterus compromising circulation due to compressed inferior vena cava and vessels of pelvic area, resulting in venous congestion in legs, vulva, and rectum. Edema of lower extremities may occur, worsens with dependency, such as prolonged standing. Varicosities, which have familial tendency, may form or enlarge from progesterone-induced vascular relaxation.

• Progressive lordosis- an inwards curvature of lumbar spine. Occurs to compensate for shifting center of balance caused by anteriorly enlarging uterus.

• Carpal tunnel syndrome- slumping of shoulders and anterior flexion of neck from increasing weight of breasts/lordosis may cause compression of medial and ulnar nerves in the arm, causing numbness and tingling.