Adaptations to Pregnancy and Prenatal Care - Practice Flashcards

A comprehensive set of practice questions (Question and Answer format) covering physiological adaptations, antepartum care, nutrition, diagnostic tests, fetal surveillance, and nursing considerations from Weeks 2–15 notes.

What is Chadwick’s sign and what causes it?

Bluish-purple discoloration of the cervix caused by congestion of blood due to increased estrogen.

What is Goodell’s sign?

Cervical softening due to changes in connective tissue (collagen fibers).

What is the function of the cervical mucus plug during pregnancy?

To seal the cervical canal and keep vaginal bacteria out.

At approximately how many weeks is the uterus palpable above the symphysis pubis?

By 12 weeks gestation.

Where is the fundus located at 16 weeks gestation?

Midway between the symphysis pubis and the umbilicus.

Where is the fundus at 20 weeks gestation?

At the umbilicus.

What is the common rule for fundal height after 20 weeks?

Fundal height in centimeters roughly equals gestational age in weeks.

When is the fundus at the xiphoid process?

Around 36 weeks gestation.

What happens to fundal height as the head descends after 36 weeks?

FH is stable or decreases (lightening).

What hormone source takes over progesterone production as the placenta develops?

The placenta eventually takes over from the corpus luteum.

When does ovulation cease during pregnancy and why?

Ovulation ceases due to elevated estrogen and progesterone inhibiting FSH and LH.

How do estrogen and progesterone affect breast tissue during pregnancy?

Estrogen stimulates growth of mammary ductal tissue; progesterone stimulates growth of lobes, lobules, and alveoli; breasts become highly vascular with visible veins.

What is Striae gravidarum and when might it appear?

Stretch marks that may appear during pregnancy.

When is colostrum typically present during pregnancy?

Between 12 and 16 weeks of pregnancy.

By how much can cardiac output increase during pregnancy?

Up to about 50%.

How does heart rate change during pregnancy?

Heart rate increases by about 15–20 beats per minute.

What happens to systemic vascular resistance and blood pressure during pregnancy?

Systemic vascular resistance decreases; blood pressure is mostly stable.

What are the hematologic and thrombotic changes during pregnancy?

Increased plasma volume causing physiologic anemia; a hypercoagulable state that protects against hemorrhage but increases VTE risk.

How does uteroplacental circulation affect renal blood flow and GFR during pregnancy?

Renal blood flow increases and GFR increases by about 50%.

What overall change occurs to blood volume and how does it relate to CO?

Blood volume increases, contributing to increased cardiac output (CO up to ~50%). CO equals stroke volume (SV) times heart rate (HR).

How does pregnancy affect breathing and oxygen consumption?

Oxygen consumption increases by ~20%; tidal volume increases by 30–40%. CO2 is reduced, causing mild respiratory alkalosis.

What hormonal effects contribute to increased airway resistance and nasal symptoms?

Progesterone relaxes smooth muscle reducing airway resistance; estrogen causes hyperemia of the respiratory tract leading to nasal congestion and epistaxis.

What gastrointestinal changes occur in the small and large intestines?

Delayed gastric emptying and slowed intestinal motility with increased absorption of some micronutrients (small intestine) and increased water absorption (large intestine) leading to constipation.

How does pregnancy affect the esophagus and heartburn risk?

Progesterone relaxes smooth muscle; lower esophageal sphincter tone decreases, leading to pyrosis (heartburn).

What change occurs in the gallbladder during pregnancy and what can this cause?

Progesterone causes a hypotonic gallbladder with thicker bile, increasing the risk of gallstones.

What happens to serum alkaline phosphatase and albumin levels during pregnancy?

Serum alkaline phosphatase rises 2–4 times normal; serum albumin and total protein may decrease.

What urinary changes occur due to the growing uterus?

Frequent urination; nocturia; bladder pressure; potential stress incontinence; ureters and renal pelvis dilate (pelviectasis) with urinary stasis increasing UTI risk.

How much does renal blood flow and GFR increase during pregnancy?

Renal blood flow increases by 50–80%; GFR increases by about 50%.

What integumentary changes are common in pregnancy?

Hyperpigmentation (chloasma, linea nigra), vascular changes (spider angiomas, palmar erythema), and striae gravidarum; hair growth changes and postpartum shedding.

What happens to hair during and after pregnancy?

During pregnancy, more hair may stay in the resting phase; postpartum, shedding occurs, and hair returns to normal 6–12 months after delivery.

What musculoskeletal changes occur due to pelvic ligament relaxation?

Estrogen and progesterone increase mobility of pelvic ligaments; symphysis may soften (28–30 weeks) causing pelvic instability, waddling gait, and potential diastasis recti.

Which hormones are involved in lactation and uterine tone, and what are their roles?

Prolactin promotes milk production; oxytocin stimulates uterine contractions and milk-letdown; progesterone supports smooth muscle relaxation to prevent contractions.

What is the role of hCG during early pregnancy?

Stimulates the corpus luteum to produce progesterone and estrogen until the placenta takes over (around 12 weeks).

What is hCS and its effect on glucose metabolism?

Human chorionic somatomammotropin (hCS) causes insulin resistance, increasing maternal glucose availability for the fetus.

What thyroid changes occur in pregnancy and why are they important?

Thyroid shows hyperplasia and ↑ vascularity; total and free T4 rise in the first trimester then normalize; maternal thyroid hormones are important for fetal brain development; BMR increases up to 25%.

What parathyroid change happens in pregnancy?

Parathyroid increases in size and helps regulate calcium levels in the blood.

What placental hormones contribute to metabolic changes and energy storage?

hCG, estrogen, progesterone, relaxin, and hCS influence metabolism, fat storage, and tissue remodeling.

What is the recommended total weight gain during pregnancy based on BMI?

Underweight: 28–40 lb; Normal weight: 25–35 lb; Overweight: 15–25 lb; Obese: 11–20 lb.

What is the meaning of 1 kg in pounds and why is it important?

1 kg equals 2.2 pounds; used to track recommended weight gain ranges.

What is the recommended pattern of weight gain across the trimesters?

Approx. 1.1–4.4 lb in the first trimester, then about 0.8–1 lb per week in the second and third trimesters.

What folic acid supplementation is recommended before and during pregnancy?

400–800 mcg daily before conception; 600 mcg daily during pregnancy; 4 mg daily if history of neural tube defect (NTD) in family.

Why is iron important in pregnancy and how should it be taken for best absorption?

Iron supports maternal RBC expansion and fetal iron stores; heme iron is preferred and absorption is best when taken between meals with vitamin C; avoid taking with milk, tea, coffee, antacids, and phytates.

What are common iron-rich foods and issues with iron in pregnancy?

Heme iron from animal sources is readily absorbed; nonheme iron absorption is lower; foods high in iron include meat, fish, poultry; absorption is enhanced with vitamin C.

What are the thresholds for anemia in pregnancy by trimester?

First and third trimesters: Hgb < 11 g/dL and Hct < 33%; Second trimester: Hgb < 10.5 g/dL and Hct < 32%.

What are the best calcium sources during pregnancy and how can absorption be enhanced?

Dairy products; calcium absorption is improved with vitamin D; there are multiple calcium-equivalent food sources listed. (Note: calcium sources listed include milk, yogurt, cheese, almonds, beans, cereals.)

What sodium guidance is given for pregnancy?

Moderation of sodium; avoid foods high in sodium such as processed snacks and canned foods.

What are key food safety precautions in pregnancy regarding mercury and raw foods?

Avoid shark, swordfish, mackerel, tilefish due to mercury; avoid raw or undercooked fish/meat/poultry/eggs; avoid unpasteurized dairy and soft cheeses; avoid pate and meat spreads; unwashed produce; risk of toxoplasmosis.

What factors influence maternal nutrition beyond diet alone?

Maternal age, nutritional knowledge, exercise, culture (hot/cold food concepts), pregnancy as a “hot” condition in some cultures and postpartum as “cold.”

What are common nutritional risk factors during pregnancy?

Socioeconomic status, adolescence, vegetarianism, lactose intolerance, nausea/vomiting, anemia, abnormal pre-pregnancy weight, eating disorders, pica, multiparity, multifetal gestation, substance use.

What is involved in a nutritional assessment during pregnancy?

Interview about appetite, habits, food preferences; psychosocial influences; physical signs of deficiency; laboratory tests; diet history (24-hour recall, food records, etc.).

What are the general nutrition guidelines after birth for lactating women?

Add about 330 calories/day for the first 6 months; an additional 170 calories from maternal stores; total around +400 calories compared to nonpregnant needs during 6–12 months PP.

What is the frequency of antenatal visits during pregnancy?

Conception to 28 weeks: every 4 weeks; 29–36 weeks: every 2 weeks; 37 weeks to birth: weekly.

What does GTPAL stand for in obstetric history?

Gravida, Term, Preterm, Abortions, Living children.

What is Nagele’s rule used for?

Calculating estimated due date from the last menstrual period: LMP minus 3 months plus 7 days (and adjust year as needed).

What is Leopold’s maneuver used for?

Abdominal palpation to determine fetal position and presentation for delivery planning.

What is the purpose of prenatal ultrasound in the first trimester?

Confirming intrauterine pregnancy (IUP), dating, viability, multiple gestation, and identifying fetal abnormalities or follow-up needs.

What are the main uses of ultrasound in the second and third trimesters?

Determining viability, fetal anatomy survey, dating, growth assessment, AFI, fetal position, amniocentesis/PUBS adjuncts.

What is the role of Doppler ultrasound in prenatal care?

Assess fetal blood flow to evaluate placental insufficiency, hypertension disorders, and fetal growth issues.

What does Alpha-Fetoprotein (AFP) screening detect and how is it measured?

Screening for neural tube defects and abdominal wall defects; measured by maternal serum AFP (MSAFP) between 16–18 weeks.

What is the purpose of a multiple-marker (quad) screening?

Screen for chromosomal abnormalities and certain congenital anomalies using MSAFP, hCG, unconjugated estriol, and inhibin A.

What is Chorionic Villus Sampling (CVS) and its timing?

Early diagnostic test (10–13 weeks) to diagnose fetal chromosomal, metabolic, or DNA abnormalities; transcervical or transabdominal approach.

What is Amniocentesis used for and when is it typically performed?

Diagnosis of fetal chromosomal/metabolic abnormalities, fetal lung maturity (L/S ratio), Rh status; typically performed midtrimester after 15 weeks.

What is PUBS and its main risks and indications?

Percutaneous umbilical blood sampling for fetal testing/management; risks include fetal loss, infection, bradycardia, cord injury.

What is Noninvasive Prenatal Testing (NIPT)?

Screening test using cell-free fetal DNA in maternal blood to assess risk for chromosomal abnormalities; can be done after ~10 weeks.

What are the three goals of antepartum fetal surveillance?

Determine fetal health or compromise; guide intervention by OB/GYN; reduce perinatal morbidity and mortality.

What is the NST and how is it interpreted?

Nonstress test: monitors fetal heart rate with movement. Reactive: accelerations (20 min <32 weeks; 10x10; ≥32 weeks; 15x15). Nonreactive requires longer monitoring.

What is vibroacoustic stimulation used for in NST testing?

Uses sound to confirm whether NST findings are reassuring and may shorten testing time.

What is a Contraction Stress Test (CST) and when is it contraindicated?

Tests fetal response to contractions. Contraindicated with preterm labor risk, PROM, prior uterine surgery, placenta previa.

What indicates a positive CST result?

Nonreassuring: late decelerations with more than 50% of contractions; equivocal results possible.

What is a Biophysical Profile (BPP) and what components are scored?

Ultrasound-based fetal well-being assessment including NST, fetal breathing, body movements, tone, and amniotic fluid volume.

What is the significance of a normal BPP score?

8–10 points with reassuring interpretation; ≤4 points suggests delivery may be considered; oligohydramnios warrants more testing.

What are kick counts and what should mothers do?

Maternal counting of fetal movements; no fixed number of movements; 5–10 movements per hour is common; seek care if pattern changes.

What are common signs of possible complications during pregnancy that require immediate attention?

Vaginal bleeding, leaking fluid, severe headache with visual changes, severe abdominal pain, vomiting with signs, decreased fetal movement, etc.

What are typical psychological responses to pregnancy by trimester?

First trimester: uncertainty/ambivalence; second: quickening and body changes; third: vulnerability and preparation for birth.

What are some parental tasks of pregnancy for mothers and fathers?

Maternal: seek safe passage, acceptance, self-giving, commitment, recognition as parent; Fathers: coping with new role, involvement; some report couvade.

What cultural factors influence childbearing and communication during pregnancy?

Health beliefs, modesty, decision-making styles, language, and practices such as concerns around modesty or traditional dietary patterns.

What is the purpose of preconception and interconception care?

Preconception: assess health, medications, vaccines, folic acid; interconception: address new problems and plan for next pregnancy.

What is the recommended folic acid supplementation to prevent neural tube defects before conception and during pregnancy?

400–800 mcg daily before conception; 600 mcg daily during pregnancy; 4 mg if history of NTD.

What are some key components of antepartum care visits?

Vital signs, fundal height, fetal heart rate, Leopold maneuvers, urinalysis, fetal movement checks, lab tests (CBC, HIV, syphilis, GTT), pap smear, ultrasound as needed.

Which vaccines are considered safe during pregnancy?

Influenza, Tdap, Hepatitis, COVID-19 vaccines, RSV (as appropriate per guidelines) to protect mother and fetus.

What are the nutrition-related weight gain guidelines by BMI category?

Underweight 28–40 lb; Normal 25–35 lb; Overweight 15–25 lb; Obese 11–20 lb.

What is the daily caloric and macronutrient guidance during pregnancy?

Energy: 2200–2900 kcal/day; Protein: ~46 g initially, rising to ~71 g later; Carbohydrates and fats provide the rest.

Why is iron supplementation common in pregnancy and what are absorption considerations?

To support maternal RBC expansion and fetal iron stores; iron absorption is better from heme iron and when taken between meals with vitamin C.

What are common nutrients and supplements emphasized in pregnancy beyond iron and folic acid?

Vitamins (A, D, E, K fat-soluble; B6, B12, C, folic acid, thiamin, riboflavin, niacin), calcium, and hydration.

What are key food safety guidelines for pregnancy regarding seafood and dairy?

Avoid high-mercury fish; avoid raw/undercooked seafood and meats; avoid unpasteurized dairy and soft cheeses; avoid pate and meat spreads.

What are the common signs of pregnancy testing used in clinical practice?

Presumptive signs (amenorrhea, nausea, fatigue, urinary frequency, breast changes), probable signs (Chadwick’s sign, Goodell’s sign, Hegar’s sign, ballottement, Braxton Hicks), and positive signs (visualization of fetus, fetal heart sounds, fetal movements).

What is the role of NST, CST, and BPP in fetal surveillance?

NST assesses fetal heart rate response to movement; CST evaluates fetal response to contractions; BPP combines NST with ultrasound-based fetal well-being assessments.

What is NIPT and when is it typically performed?

Noninvasive prenatal testing using cell-free fetal DNA in maternal blood; can be performed after about 10 weeks.

What is the significance of a 20-week anatomy scan?

An anatomy survey to assess fetal anatomy and growth; part of routine second-trimester ultrasound.

What is the clinical usefulness of a growth scan near term (36 weeks)?

Assess fetal growth and amniotic fluid; helpful in monitoring multifetal gestation or growth concerns.

What is the difference between presumptive, probable, and positive signs of pregnancy?

Presumptive signs are subjective experiences reported by the woman; probable signs are examiner-confirmed but not unique to pregnancy; positive signs confirm pregnancy (fetus or fetal parts visualized or heard).

What is the nursing process sequence used in prenatal care?

Assessment, Diagnosis, Planning, Implementation (education/teaching/support), Evaluation.

What are some common discomforts of pregnancy listed in the notes?

Nausea and vomiting, heartburn, backache, round ligament pain, urinary frequency, varicosities, constipation/hemorrhoids, leg cramps, edema.

What is the concept of lightening and its visual effect?

Descent of the fetal head into the pelvis often leads to reduced diaphragmatic pressure and a change in fundal height.