N354: Norms 2026

Early term

37 0/7 - 38 6/7 weeks

Full term

39 0/7 - 40 6/7 weeks

Late term

41 0/7 - 41 6/7

Post term

≥ 42 0/7 weeks +

GTPAL

• Gravida (# of pregnancies including current)

• Term ( # pregnancies carried to and delivered at 37+ weeks)

• Preterm (# pregnancies carried and delivered between 20-36.6 weeks)

• Abortions (# losses prior to 20 weeks — including spontaneous & therapeutic abortions)

• Living children

Recommended total weight gain throughout pregnancy

• Normal BMI: 25-35 lbs.

• Underweight (BMI < 18.5) = 28-40 lbs.

• Overweight (BMI 25-29.9) = 15-25lbs

• Obese (BMI 30+) = 11-20lbs

• Twins with Normal BMI = 37-54 lbs

Leopold’s maneuver

• determine fetal presentation, position, & presenting part

• Aid in locating fetal heart tones

• Fetal size assessment

• Determination of single vs. multiple gestations

Changes in breasts during pregnancy

• Size ↑ noted primary in 1st 20 weeks

• Become nodular

• Tingling sensation in 1st & 3rd trimesters; heaviness may be reported

• Nipple & Areola pigmentation darkens

• Superficial Veins: dilate, more prominent

• Striae seen in multiparas

• Tubercles of Montgomery enlarge

• Colostrum possibly present after 12th week

• 2°Areola appears after 20 weeks (series of washed-out spots surrounding 1° areola)

• Less firm, old striae may be present in multiparas

Presumptive s/s of pregnancy

• Amenorrhea

• N/V

• Urinary frequency

• Excessive fatigue

• Breast tenderness

• Quickening

Probably s/s of pregnancy

• Goodell Sign - softening of cervix

• Chadwick Sign - deep red to purple/ bluish coloration of mucous membranes of cervix, vagina, & vulva d/t vasocongestion of pelvic vessels

• Hegar Sign - softening of uterine isthmus (b/w uterine body & cervix) during weeks 6-8

• Ladin Sign - soft spot anteriorly in middle of uterus near junction of uterine body & cervix

• McDonald Sign - ease in flexing body of uterus against cervix

• Braun con Fernwald Sign - irregular softening & enlargement at implantation site; occurs about 5th week

• Uterine Enlargement & Softening - present after 8th week

Common physiologic stressors and ways of alleviating them

• Nausea and vomiting

  • Avoid odors of some foods

  • Consume small meals frequently

  • Change positions slowly

• Constipation

  • Consume high fiber diet

  • Drink adequate amounts of water (2L/day)

  • May obtain laxatives or stool softeners

• Heartburn

  • Do not overeat fatty and fried foods

  • Drink adequate amounts of water (2L/day)

• Varicose veins

  • Adequate exercise and avoid standing or sitting for long periods

  • Elevate feet when one is lying down

  • Dorsiflex feet and hold that position for several seconds, then release. Repeat 10 times a day.

• Edema

  • Reduce sodium intake

  • Drink adequate amounts of water (2L/day)

  • Elevate feet when one is lying down

• Backache

  • Sleep on side with pillows as support between legs/behind back

  • Heating pad on back only

  • Massage

  • Wear belly band to assist in supporting weight of growing belly and assist with lordosis

Gestational Hypertension

• elevated BP > 140/90 developing after 20 weeks of pregnancy

• Often resolves after delivery by 12 weeks postpartum

• Induction of labor is generally recommended once the patient is at term (37 weeks) due to

• increased risks of GHTN turning into preeclampsia.

Preeclampsia

• new-onset high blood pressure (≥140/90 mmHg) after 20 weeks of pregnancy,

• accompanied by either proteinuria (protein in urine) OR new signs of end-organ damage, such as low platelets, liver/kidney issues, fluid in lungs, or brain problems (even without proteinuria)

• Main pathologic feature of preeclampsia

  • Incomplete transformation of the uterine spiral arteries, resulting in hypoperfusion of the placenta and reduced nutrient supply to the fetus

  • Generalized vasoconstriction of the mother leading to poor perfusion to the kidneys, liver, and brain

S/S of preeclampsia

• (may not present with all; diagnostic criteria includes HTN along with kidney, liver, or CNS involvement)

  • Impaired kidney function → proteinuria, decreased urine output, increased BUN and serum creatinine

  • Impaired liver function (elevated AST/ALT), edema &/or necrosis of liver causing RUQ/epigastric pain; thrombocytopenia with platelets < 100,000

  • Impaired CNS function: Severe headaches, temporary loss of vision, blurred vision, photophobia, & scotoma (seeing spots/floaters), hyperreflexia, + clonus

Gestational diabetes (GDM)

• elevated level of glucose with the first onset during pregnancy; usually resolves postpartum. Glucose Tolerance Testing (GTT) labs performed around 28 weeks gestation on all pregnancies to determine if GDM

Prenatal GDM medical management

• Early screening for high-risk patients

• Use of continuous glucose monitoring (CGM) in some cases

• Parent teaching regarding proper diet, exercise, self-monitoring of glucose levels, and usage of insulin or po medications

• Postpartum follow-up for all GDM patients

Cervical ripening agents

• Misoprostol (Cytotec)

• Dinoprostone (Cervidil)

• Pitocin

Effacement

• Thinning & shortening of the cervix, 100% means fully thinned-out, 0% means it hasn’t thinned out yet. 100% = completely effaced. The thinner/more effaced the cervix is, the easier for it to dilate/open.