Adaptations to pregnancy

week 1 chapter 13

true or false: the pattern of uterine growth provides information about fetal growth and the estimated date of delivery

true

what is it called when the baby drops and pressure moves from the diaphragm to the uterus

lightening

• usually happens around the beginning of the third trimester (~37wks), signaling the baby's readiness for birth.

• It often occurs several weeks before labor starts.

what are Braxton Hicks contractions

Irregular, usually painless contractions that occur in the late stages of pregnancy, often referred to as "practice contractions" for the body as it prepares for labor.

why is postpartum hemorrhage a risk in labor

because there is a dramatic increase in blood flow during labor

• 1200 ml of blood to uterus during birth

what hormone causes hyperemia

the increasing of estrogen causes hyperemia

what is Chadwicks sign

when the labia turns a blue/purple tone

• caused by an increase in vascular blood flow

what is Goodells Sign

when the cervix softens and becomes more elastic

how does estrogen and progesterone production effect the breast during pregnancy

Estrogen: causes growth of the mammary ductal tissue

Progesterone: promotes growth of the lobes, lobules, and alveoli

what is colostrum and when does it become present

Colostrum is the earliest milk produced by the mammary glands. It is thicker, more yellow or golden in color, and highly concentrated compared to mature breast milk, rich in nutrients and antibodies that support a newborn’s immune system and growth

• present 12-16 weeks gestation and present few days post birth.

Typical cardiovascular changes in pregnancy (think vitals)

• increased cardiac output but not increased BP

• increased RBCs by 250-450ml

• Increased HR by 15-20 beats/min

what is Pseudo-anemia of pregnancy

false anemia

• 10-12 is normal

• <10 = anemia

what is supine hypotension

• what are the S&S

when mother is lying flat, the vena cava and aorta are compressed by the fetus, cutting off the blood supply.

• faintness, lightheadedness, and dizziness

• nausea

• agitation

relieved by repositioning: sitting up, right lateral position

how do respirations change in pregnant pt

• oxygen consumption increases by 20%

• slight hyperventilation/deep breathing and decreased away resistance allows the increase in oxygen need to be met

how may hormonal changes impact the respiratory system

increase of estrogen leads to congestion in the upper resp, tract = nasal stuffiness, nose bleeds, deepened voice, and fullness in ears

how does the gastrointestinal system change during pregnancy (mouth? GI?)

• increase in salivation

• increase heartburn (pyrosis)

• increased emptying of the intestines

  • better absorption for the baby of various nutrients except B vitamins (decreases)

• increase risk for constipation (decreased mobility)

how does the urinary system change in pregnancy

theres an increase in frequency of urination

• likely from baby sitting on bladder

• change in size and shape of kidneys and ureters

what is the #1 cause of preterm labor

UTIs

• there is an increased risk due to stasis of urine

• UTIs = risk of bacteria = risk of sepsis

examples of presumptive pregnancy indications (early signs, more internal)

• amenorrhea

• nausea and vomiting

• fatigue

• urinary frequency

• breast, vaginal, cervical, and skin changes and color

• fetal movement (could be gas)

examples of probable pregnancy indications (some objective changes)

• abdominal enlargement

• cervical softening

• changes in uterus

  • uterine consistency

  • ballottement

  • braxton hicks

  • palpation of fetal outline

  • uterine souffle

• pregnancy test

what is Ballottement

Ballottement is a physical examination technique used to detect a fetus suspended in amniotic fluid. During the test, a healthcare provider applies a gentle, sharp tap or upward pressure on the cervix or lower uterine segment, either vaginally or abdominally. The fetus, buoyed by the amniotic fluid, moves away from the pressure and then rebounds, producing a palpable “bounce” against the examiner’s fingers.

what are positive pregnancy indications

this is done by a Doctor, NP, or midwife, NOT RN

• auscultation of fetal heart tones

• fetal movement by examiner

• visualization of the fetus

what is the purpose of preconception care

to identify and problems that may be harmful once pregnancy occurs and to teach health behaviors to help achieve a healthy pregnancy

• assess pt health problems

• social history

• medications

• physical examination

what does the initial first visit include (during prenatal stage (before pregnant) maybe first appointment period if unexpected?)

• obstetrical history

• complete medical and surgical history

• physical exam

• vitals

• labs (urinalysis)

• risk assessment (abuse, pets, financial))

gravida?

primigravida?

multigravidia?

para?

• gravida- a women who is or has been pregnant

• primigravida- a women who is pregnant for he first time

• multigravida- a women who has been pregnant more than once

• para- # of pregnancy that end at 20wks gestation or more

what does GTPAL stand for when calculating gravida and para

how do you determine the dute date EDD, using Nageles rule

1. first day of last menstrual period (LMP)

2. subtract 3 months

3. add 7 days

4. update the year as needed

what are routine labs done during pregnancy

• Blood type, Rh factor, antibody screening

• CBC → Hgb, Hct

• Glucose Challenge test- test for gestational diabetes

• rubella titer

• hep b

• HIV

• urinalysis

• STI and group B streptococci (GBS)

how often are prenatal appointments

• conception to 28 wks: every 4wks

• 29-36wks: every 2 weeks

• 37wks to birth: weekly

what should each prenatal care appointment consist of- what assessments are done

• vitals

• weight

• urinalysis

• fundal height (should be +- 2cm)

• Leopold’s maneuver

• fetal HR (110-160)

• fetal movement (16-20wks)

• ultrasound

what are we assessing for when sending a urinalysis

positive nitrate = infection

protein = preeclampsia

^ glucose = gestational diabetes

what screenings are done at 28wks

• fetal kick counts

• rhogam injection if indicated

• TDAP vaccine

what screenings are performed at 36wks

• group B strep screen

• hemoglobin and hematocrit

• Leopold’s maneuver

• STI testing (gonorrhea and chlamydia)

what immunizations are safe/expected during pregnancy

• TDAP (28wks)

• Flu

• Covid

• RSV

• Rhogam (if needed)

what immunizations are NOT SAFE during pregnancy

NO LIVE VACCINES

• papillomavirus

• live influenza vaccine in nasal spray form

• measles, mumps, rubella (MMR)

what are signs of potential concerns during pregnancy

• vaginal bleeding

• swelling of fingers, face/eyes

• continuous headache

• visual disturbances

• persistent abdominal pain

• chills/fever

• painful urination

• fetal movement changes in frequency or strength

• signs of preterm labor: cramps, low backache, pelvic pressure