Exam 2

Why should smoking and secondhand smoke be avoided during pregnancy?

Smoking and secondhand smoke can cause preterm labor and low birth weight; no amount is considered safe.

What are the maternal effects of smoking during pregnancy?

Increased risk of abruptio placenta, premature rupture of membranes (PROM), preterm labor, and spontaneous abortion.

What are the fetal effects of smoking during pregnancy?

Low birth weight, intrauterine growth restriction (IUGR), prematurity, neurodevelopmental problems, increased risk for SIDS, and colic.

What are the childhood effects linked to prenatal exposure to smoking?

Increased risk of asthma and obesity.

What is a recommended method to manage nicotine withdrawal during pregnancy?

Nicotine patches can be used to curb withdrawal effects, but should be used with medical guidance.

What condition in newborns is strongly associated with maternal smoking?

Sudden Infant Death Syndrome (SIDS).

Why should alcohol be avoided during pregnancy?

Alcohol can cause fetal alcohol syndrome and is linked to lifelong developmental issues; no amount is considered safe.

What are the maternal effects of alcohol use during pregnancy?

Increased risk for abruptio placenta and spontaneous abortion.

What are the fetal effects of alcohol use during pregnancy?

Fetal demise and fetal alcohol spectrum disorders, including fetal alcohol syndrome (FAS).

What are the characteristic facial anomalies of fetal alcohol syndrome (FAS)?

Microcephaly, short palpebral fissures, epicanthal folds, flat midface, low nasal bridge, indistinct philtrum, and thin upper lip.

What childhood effects are associated with prenatal alcohol exposure?

Increased risk for hyperactivity, fine motor dysfunction, and cognitive impairment.

What does a decreased platelet count indicate in pregnancy?

It may suggest impaired hepatic function, specifically decreased thrombopoietin production.

What does an elevated AST/ALT level indicate?

Elevated AST/ALT suggests hepatic involvement or liver dysfunction.

What does a decreased glomerular filtration rate (GFR) indicate?

It reflects renal impairment or decreased kidney function.

What does elevated serum uric acid indicate in pregnancy?

It suggests renal dysfunction and is commonly elevated in preeclampsia.

What is considered a diagnostic level of proteinuria in pregnancy?

300 mg/dL or more in a 24-hour urine collection or a protein-to-creatinine ratio ≥ 0.3, especially when combined with hypertension, confirms preeclampsia.

What organ systems are involved when proteinuria is present with hypertension?

Renal and cardiovascular systems.

What does elevated serum creatinine indicate in pregnancy?

Renal dysfunction or impaired kidney filtration.

What does an elevated serum lactate level indicate?

It indicates generalized vasospasm and resulting tissue damage.

What are the danger signs in the second and third trimester that may indicate infection?

• Persistent, severe vomiting (flu, food poisoning)

• Chills, fever, burning on urination, diarrhea (UTI, pyelonephritis)

• Severe backache or flank pain (UTI, pyelonephritis)

What are the danger signs that may indicate preterm labor or complications with membranes?

• Sudden discharge of fluid from vagina before 37 weeks (PROM)

• Uterine contractions, pressure, cramping before 37 weeks (preterm labor, dehydration)

What are the danger signs that may indicate placental complications?

• Vaginal bleeding

• Severe abdominal pain
  (Indicates abruption or placenta previa)

What are the danger signs related to fetal well-being?

• Change in fetal movements

• Absence of fetal movements

• Any unusual change in fetal movement pattern
  (Indicates risk for intrauterine demise or low amniotic fluid)

What are signs of hypertensive disorders or preeclampsia?

• Visual disturbances (blurring, double vision, spots)

• Swelling of face or fingers and over sacrum

• Severe, frequent, or continuous headaches

• Muscular irritability or convulsions

• Epigastric or abdominal pain (preeclampsia, HELLP)

What are signs of possible gestational diabetes?

Glycosuria and a positive glucose tolerance test.

What are considered positive signs of pregnancy?

• Visualization of a fetus in real-time via ultrasound (US)

• Fetal heart tones detected by ultrasound

• Visualization of fetus by radiographic study

• Fetal heart tones detected by Doppler ultrasound stethoscope

• Fetal heart tones detected by a fetal stethoscope

• Fetal movements palpated by examiner

• Fetal movements visible to examiner

Why are these signs considered "positive" signs of pregnancy?

Because they provide direct, conclusive evidence of a developing fetus.

What hormone does a pregnancy test detect to confirm pregnancy?

Human chorionic gonadotropin (hCG).

What is the difference between a serum and urine pregnancy test?

A serum test detects hCG in blood and is more sensitive; a urine test detects hCG in urine and is most accurate with the first morning void.

What are possible false-positive causes of a pregnancy test?

• Molar pregnancy (hydatidiform mole)

• Choriocarcinoma

• Pelvic infection

• Uterine tumors

What are presumptive signs of pregnancy?

Subjective signs felt by the woman that could indicate pregnancy but are not definitive.

What are examples of presumptive signs of pregnancy?

• Breast tenderness or enlargement

• Amenorrhea

• Nausea and vomiting

• Urinary frequency

• Fatigue

• Quickening

What is quickening and when does it typically occur?

The mother's perception of fetal movement, typically felt around 16–20 weeks' gestation.

Why are presumptive signs not considered diagnostic of pregnancy?

Because they can be caused by conditions unrelated to pregnancy (e.g., GI disorders, infections, stress).

What are probable signs of pregnancy?

Objective signs observed by a clinician that strongly suggest pregnancy but are not conclusive.

What are examples of probable signs of pregnancy?

• Goodell sign (soft cervix)

• Chadwick sign (bluish discoloration of cervix/vagina)

• Hegar sign (soft isthmus)

• Positive serum or urine pregnancy test

• Braxton Hicks contractions

• Ballottement

What is ballottement and what does it indicate?

assive fetal movement in response to tapping the cervix; suggests a floating fetus but could also indicate a tumor or polyp.

Why are probable signs not considered positive signs of pregnancy?

Because they can be caused by non-pregnancy conditions such as tumors or vascular congestion.

What causes hyperpigmentation during pregnancy?

Elevated estrogen levels, leading to conditions such as chloasma and linea nigra.

What is chloasma and where does it appear?

Also called the "mask of pregnancy," it’s the darkening of the skin on the face, especially the forehead, cheeks, and nose.

What is the linea nigra?

A dark vertical line that appears on the midline of the abdomen during pregnancy.

What are striae and where are they commonly found?

Stretch marks that occur due to rapid growth, commonly on the abdomen, hips, breasts, and thighs.

What happens to hair growth during and after pregnancy?

Hair growth decreases due to a decrease in dormant follicle phase; hair shedding commonly occurs up to 3 months postpartum.

Do skin changes like hyperpigmentation fade after birth?

Yes, many skin changes such as chloasma and linea nigra typically fade during the postpartum period.

What is fundal height?

It is the measurement from the symphysis pubis to the top of the uterine fundus, used to estimate gestational age.

What tool is used to measure fundal height?

A measuring tape.

What is the general rule for fundal height after 18 weeks gestation?

The fundal height in centimeters should approximately match the weeks of gestation (±2 cm).

Up to what week of pregnancy is fundal height typically measured?

Up to the 36th week of pregnancy.

What does a fundal height of 20 cm suggest?

That the woman is approximately 20 weeks pregnant.

What defines a high-risk pregnancy?

A pregnancy with a higher chance of complications affecting the mother, fetus, or both, due to medical, genetic, environmental, or social factors.

What are common biophysical risk factors in high-risk pregnancy?

• Chromosomal abnormalities (e.g., Down syndrome)

• Multiple gestation

• ABO/Rh incompatibilities

• Inherited genetic disorders

• Large fetal size

• Nutritional deficiencies

• Poorly controlled diabetes

• Hypertensive disorders

What fetal complications can result from poor glycemic control in gestational diabetes?

Congenital abnormalities such as neural tube defects and organ malformations.

What fetal issue can occur with placenta previa?

Intrauterine growth restriction (IUGR).

What fetal condition can occur from oligohydramnios?

Nuchal cord and growth restriction.

What are common psychosocial risk factors in high-risk pregnancy?

• Smoking

• Substance misuse

• Emotional distress

• History of mental illness

• Inadequate social support

• Unsafe cultural practices

How can psychosocial stress impact pregnancy outcomes?

It can increase the risk for preterm birth, low birth weight, and developmental issues.

What are sociodemographic risk factors associated with high-risk pregnancies?

• Low income

• Limited access to prenatal care

• Adolescent or advanced maternal age (>35 y.o.)

• High parity

• Unmarried status

• Minority ethnicity

What are environmental exposures that increase pregnancy risk?

• Secondhand smoke

• Anesthetic gases

• Radiation

• Chemicals

• Environmental pollutants

• Certain therapeutic medications

What are the most common conditions that contribute to high-risk pregnancy?

• Diabetes

• Hypertension

• Preeclampsia

• Fetal growth restriction

• Multiple gestation

• Oligohydramnios

• Preterm premature rupture of membranes

• Postterm pregnancy

• Previous stillbirth

• Systemic lupus erythematosus

• Cholestasis of pregnancy

• Renal disease

• Decreased fetal movement

What is the recommended weight gain during pregnancy for an average-weight patient?

25 to 35 lb (11.3 to 15.8 kg).

What is the recommended weight gain during pregnancy for an underweight patient?

28 to 40 lb (12.7 to 18.1 kg).

What is the recommended weight gain during pregnancy for an overweight patient?

15 to 25 lb (6.8 to 11.3 kg).

Why should caffeine be limited or avoided during pregnancy?

It can increase the risk of spontaneous abortion and/or preterm labor; long-term developmental effects on the child are not fully understood.

Why should alcohol be avoided during pregnancy?

It can cause fetal alcohol syndrome and other fetal alcohol spectrum disorders, leading to lifelong developmental and cognitive impairments.

What dietary habits help reduce nausea and vomiting in pregnancy?

• Eat small, frequent meals

• Avoid greasy foods

• Follow a bland diet (e.g., BRAT diet: bananas, rice, applesauce, toast)

• Avoid foods or odors that trigger nausea

• Avoid drinking fluids right before bed

How much protein should a pregnant woman consume daily?

60–70 grams per day (higher if pregnant with multiples).

Sources: Meats, eggs, cheese, yogurt, legumes, nuts, and grains.

How much water should a pregnant woman drink per day?

At least 3 liters (3,000 mL) per day.

How much fiber should be consumed daily during pregnancy?

25–30 grams per day.

Sources: Whole grains, bran, vegetables, fruits, nuts, seeds.

How much calcium is recommended during pregnancy, and what are good sources?

1000–1300 mg per day.

Sources: Milk, cheese, fish, dark leafy vegetables, baked beans.

What is the recommended daily intake of iron during pregnancy?

25–30 mg per day.

Sources: Liver, meats, legumes, dark green leafy vegetables, dried fruit.

How much zinc is needed during pregnancy and what are good sources?

11–12 mg per day.

Sources: Liver, shellfish, meats, whole grains, milk.

What is the recommended iodine intake in pregnancy?

200–250 mcg per day.

Sources: Iodized salt, eggs, dairy products.

How much magnesium is recommended during pregnancy?

350–400 mg per day.

Sources: Nuts, legumes, cocoa, whole grains.

What is the daily recommendation for vitamin A during pregnancy?

750 mcg per day.

Sources: Dark leafy vegetables, liver, dark yellow vegetables/fruits, fortified butter.

How much vitamin D is needed daily during pregnancy?

600 IU per day.

Sources: Fortified milk/cereals, salmon, tuna, butter, liver.

What is the recommended intake of vitamin E during pregnancy?

15 mg per day.

Sources: Vegetable oils, leafy vegetables, whole grains, liver, nuts, cheese, fish.

How much vitamin C should pregnant women consume?

80–85 mg per day.

Sources: Citrus fruits, strawberries, broccoli, tomatoes, peppers, potatoes, raw dark leafy greens.

What is the recommended intake of folic acid during pregnancy?

0.4–0.6 mg per day.

Sources: Fortified cereals, green leafy vegetables, oranges, broccoli, asparagus, artichokes, liver.

What is a common cause of constipation during pregnancy?

Increased progesterone levels, which slow down gastrointestinal (GI) motility.

How does progesterone contribute to constipation during pregnancy?

Progesterone relaxes smooth muscle, including the intestines, leading to slower peristalsis and delayed bowel movements.

Besides hormone changes, what other factors can contribute to constipation in pregnancy?

Iron supplementation, decreased physical activity, and pressure from the growing uterus on the intestines.

What are some non-pharmacological interventions to relieve constipation in pregnancy?

• Increase dietary fiber intake

• Drink plenty of water (at least 3 L/day)

• Engage in regular physical activity

• Eat fruits, vegetables, and whole grains

What causes neonatal hypoglycemia in infants of diabetic mothers?

Maternal hyperglycemia causes excess glucose transfer to the fetus, leading to increased fetal insulin production. After birth, maternal glucose supply stops, but insulin remains high, causing rapid hypoglycemia.

What is the pathophysiology behind neonatal hypoglycemia?

Chronic fetal hyperglycemia stimulates the islets of Langerhans to undergo hypertrophy and hyperplasia → excessive insulin at birth → glucose drops quickly once umbilical cord is cut.

What is considered a low blood glucose level in a newborn?

Varies by institution, but typically <40 mg/dL in the first few hours of life is considered hypoglycemia.

What congenital conditions are associated with poor glycemic control during pregnancy?

• Neural tube defects

• Caudal regression syndrome

• Cardiac defects

• Macrosomia

What is macrosomia, and why is it a concern?

It is when the fetus weighs more than 4000 g, increasing risk for birth trauma and metabolic complications like hypoglycemia.

What are the long-term risks of uncontrolled maternal blood glucose on fetal development?

Increased risk of spontaneous abortion, major fetal malformations, and neonatal hypoglycemia.

What is Nägele’s Rule for calculating the estimated date of birth (EDB)?

Start with the first day of the last menstrual period (LMP), subtract 3 months, add 7 days, then add 1 year.

What is an alternate method to calculate the EDB using Nägele’s Rule?

Add 7 days to the LMP and count forward 9 months.

How accurate is Nägele’s Rule?

It is an estimate—most women give birth within 7 days before or after the calculated EDB.

What is the importance of knowing the LMP in pregnancy dating?

It provides the basis for estimating the due date and scheduling prenatal care and screenings.

What is the formula for calculating the estimated due date (EDB) using Nägele’s Rule?

EDB = First day of Last Menstrual Period (LMP)
→ Minus 3 months
→ Plus 7 days
→ Plus 1 year (if needed)

What happens to hemoglobin and hematocrit levels in the immediate postpartum period?

They slightly decrease during the first 24 hours postpartum.

When do hemoglobin and hematocrit levels return to non-pregnant values?

They begin to rise by day 3–4 and return to normal by 4–8 weeks postpartum.

How high can the WBC count rise during labor and immediately after birth?

Up to 30,000/mm³.

When does the WBC count return to normal postpartum?

Within 1–2 weeks.

Why is leukocytosis significant postpartum?

It can obscure the diagnosis of acute infection.

Why are platelets monitored postpartum?

To assess bleeding risk as part of a complete blood count (CBC).

What happens to clotting factors and fibrinogen during and after pregnancy?

They are elevated, increasing the risk of venous thromboembolism and pulmonary embolism for up to 12 weeks postpartum.