OB Week 5 -- Normal Pregnancy and Prenatal Care

Presumptive signs

Subjective signs that may not be associated with pregnancy

Amenorrhea, NV, fatigue, urinary frequency, breast change and quickening

Probable signs

Objective signs may not be associated with pregnancy

Piskacek sign- uterine bulge

Hegar sign- softening of the uterus

Goodell sign- softening of the cervix

Chadwick- blueish cervix, vag., labia

Braxton hicks contractions

Positive signs

Diagnostic sign of pregnancy

Fetal heartbeat, fetal movement felt by examiner, fetus on ultrasound

EDD

Expected date of delivery

How to calculate EDD

First trimester timing

First day of LMP through the end of week 13

Second trimester timing

Week 14 through the end of week 27

Third trimester timing

Week 28 through the end of week 40

Prenatal visit schedule

8-10 weeks, 12 weeks, 20 weeks, 36 weeks

Nuchal translucency screening

Ultrasound screening to measure fetal nuchal folds --> assess for potential Down Syndrome

Between 10-13 weeks

Quad blood test

Blood test to detect fetal genetic abnormalities

Between 15-22 weeks

Chorionic Villus Sampling

Sampling of placental tissues for prenatal diagnosis of potential genetic disorders

Between 10-12 weeks

Amniocentesis

Sampling of amniotic fluid using a hollow needle inserted into the uterus --> screens for developmental abnormalities in a fetus

15-18 weeks

Urine dip test

Urine test to detect sugar, protein, ketones, bacteria, and blood cells in urine --> r/o UTI, gestational diabetes, or preeclampsia

Fundal height test

Food to avoid during pregnancy

Alcohol, uncooked fish, unpasteurized foods (brie, raw cheeses), raw eggs

Pregnancy diet

Increase 300 calories, drink 1/2 of body weight in water, lots of protein!

Why do pts take prenatal vitamins?

Cover any nutritional gaps, decrease the risk of neural tube defects (spina bifida B9 deficiency)

Category A drugs

Studies indicate no risk to the human fetus

Prenatal vitamins, insulin, folic acid

Category B drugs

Studies indicate no risk to the animal fetus; information for humans is not available

OTC meds (tylenol)

Category C drugs

Adverse effects reported in the animal fetus; information for humans is not available

Category D drugs

Possible fetal risk in humans --> benefits may outweigh risk

motirin

Category X drugs

Definite fetal risk in humans --> benefits outweigh risk

How much weight should pregnant women gain?

Between 25-35 lbs

Substance use during pregnancy

No alcohol, no illicit drugs, no weed, certain antidepressants, certain anti-anxiety meds

Estrogen

Causes growth of pregnancy --> breast enlargement, uterine tissue enlargement, increased uterine contractility

Progesterone

Maintains pregnancy --> Slows GI tract, relaxation of uterus and smooth muscle, vasodilation

Reproductive system changes

Neurological changes

Cardiac shanges

Blood changes

Supine hypotensive syndrome

Respiratory system changes

GI system changes

Urinary changes

Ureters changes

Morning sickness

Nausea during the first few months of pregnancy due to increased estrogen and progesterone

Why is nasal congestion common in pregnancy?

Estrogen and progesterone increase blood supply --> swelling an excess mucus

Leukorrhea

White discharge from the vagina --> could be STIs or bacterial vaginosis

Dyspepsia

Difficult digestion --> due to progesterone and enlarged uterus

Ptylism

Excessive saliva

Flatulence

Constipation

Dental problems

Leg cramps

Dependent edema

Nocturia

Insomnia

Round ligament pain

Numbness and tingling in fingers

Varicosities

Dyspareunia (painful intercourse)

1st trimester common complaints

2nd trimester common complaints

3rd trimester common complaints

Warning signs in pregnancy

Vaginal bleeding, cramping/contractions, N/V over 24 hrs, headache, vision changes, leaking of fluid, decrease in fetal movement, fever, chest pain/trouble breathing, UTI symptoms