NURS 330-01 Exam 1: Maternal Adaptation During Pregnancy

Antepartum

Prior to labor and childbirth

Intrapartum

Onset of labor through delivery of the placenta

Postpartum

After birth until the return of reproductive organs to normal nonpregnant state (approximately 6 weeks)

Gestation

Process of carrying embryo/fetus in the uterus.

Abortion

Loss of pregnancy prior to 20 weeks gestation.

Stillbirth

Fetal death occurring at 20 weeks or later.

Term (delivery time)

37-42 weeks

Preterm

<37 weeks

Early Term

37-38/6 weeks

Full Term

39-40/6 weeks

Late term

41-41/6 weeks

Postterm

>42 weeks

Gravida

Number of pregnancies, regardless of result, including current pregnancy.

Parity

Number of births after 20 weeks.

Term (GPTPAL)

Number of deliveries after 37 weeks

Preterm (GPTPAL)

Number of deliveries from 20 weeks to 36/6 weeks.

Abortions (GPTPAL)

Number of pregnancy losses prior to 20 weeks.

Living (GPTPAL)

Number of living children currently.

What are presumptive signs of pregnancy?

Subjective signs experiences by mother, can be explained by pregnancy or other condition.

What are probable signs?

Objective signs found by examiner, likely explained by pregnancy.

What are positive signs of pregnancy?

Objective signs that can only be explained by pregnancy.

Examples of presumptive signs of pregnancy

Amenorrhea, N/V, breast tenderness/changes, fatigue, weight gain, urinary frequency, quickening.

Examples of probable signs of pregnancy

Hegar’s sign, Chadwick’s sign, Goodell’s sign, Ballottement, enlargement of abdomen, fetal outline palpable.

Hegar’s Sign

Softening and compressibility of the lower uterus.

Chadwick’s Sign

Bluish discoloration of cervix and vaginal mucosa related to increased vascularity.

Goodell’s Sign

Softening of the cervix.

Ballottement

Finger inserted into vagina, sharp upward push against the uterine wall. Positive will feel the fetus bounce back and producing a return impact.

Examples of positive signs of pregnancy

Fetal visualization on ultrasound, fetal heart tones, and fetal movement detected/palpated by examiner.

What should be used for a urine hCG test?

First voided morning urine.

McDonald’s Rule

Fundal height by approx 20 weeks correlates with gestation age in cm.

How is fundal height measured?

From the symphysis pubis to the top of the uterus.

Where is the fundus at 12 weeks?

Slightly above the symphysis pubis.

Possible causes of large fundal height

Polyhydramnios, macrosomic fetus, multiple fetuses.

Possible causes of small fundal height

Oligohydramnios, intrauterine growth restriction.

Braxton Hicks Contractions

False or practice contractions, beginning at approximately 20 weeks.

Lightening

Occurs at 38-40 weeks. Fundal height decreases as fetus descends into pelvis for birth.

Mucus Plug

Thick glob of mucus in the cervix during pregnancy, can be lost later in pregnancy.

What are some changes to the vagina during pregnancy?

More alkaline pH, at risk for vaginitis. Glycogen rich, at risk for candidiasis. Leukorrhea, increased white/grey discharge.

What are some changes to breasts during pregnancy?

Enlargement causing heaviness, fullness, and tenderness. Darking and growth of nipple and areola.

Striae Gravidarum

Stretch marks. Genetic. Common on breasts, abdomen, buttocks, and thighs.

Cholasma

Dark patchy appearance of face. Mask of pregnancy.

Linea Nigra

Dark line along abdomen from symphysis pubis to umbilicus.

What are cardiovascular changes of pregnancy?

Increased blood volume by 30-50%. Slight increase of heart rate. S3 or systolic murmur possible. Little to no change in pre-pregnancy BP. Elevated clotting factors, hypercoaguable state. Physiologic anemia due to hemodilution.

Normal pregnancy H&H

Hgb: 12-16 & Hct: 38-47. Iron supplementation recommended with Hgb>11

Vena Cava Syndrome

Hypotension caused by compression of vena cava when laying in a supine position.

Respiratory changes of pregnancy

Higher oxygen demand, slight increase in respiratory rate. Decreased lung capacity due to uteran pressure on diaphragm.

GI changes of pregnancy

N/V, constipatioin, heartburn, food aversions or cravings, PICA

Renal changes of pregnancy

Increased GFR, increased urinary frequency despite urine output remaining the same.

Musculoskeletal changes of pregnancy

Relaxin causes increased mobility of joints, specifically in pelvis. Lordosis, pain, change incenter of gravity/balance possible. Diastasis recti.

Diastasis recti

Separation of the left and right large abdominal muscles during pregnancy. Often permanent.

Endocrine changes of pregnancy

Increased BMR, increased nutritional needs, placental hormone production.

Pattern of weight gain in pregnancy

3.5-5lbs in first trimester. 1lb per week in 2nd and 3rd trimester. Recommendations differ based on pre-pregnancy BMI.

Additional Energy needs in pregnancy

340 cal per day in 2nd trimester, 450 cal per day in 3rd trimester

Fluid needs in pregnancy.

8-10 glasses of fluid per day, at least 4-6 should be water. Other good fluids are milk and some fruit juice.

Increased nutrient needs in pregnancy

Protein and calcium. Folic acid to reduce neural tube defects (400-600 mcg), B6 can help with N/V, Vitamin C to improve iron absorption. Iron.

Iron Supplementation

Recommended 2nd and 3rd trimester. Empty stomach, vitamin c improve absorption. Caffeine and dairy inhibit absorption. Animal sources absorbed better. Can cause GI discomfort.

Poor outcomes of iron deficiency anemia

pre-term birth, LBW, maternal/infant mortality, low iron in fetal liver stores.

Safe amount of caffeine

<200 mg daily. Excess can cause infertility, miscarriage, IUGR

Fish and mercury levels

Avoid long-living fish such as shark, swordfish, tuna, king mackerel, tile fish.

Listeriosis Risk

Found in hot dogs, lunch meat, deli, meat, soft cheese, meat spreads, raw dairy.

What is PICA?

Compulsive ingestion of craving of non-food substances with little or no nutritional value. Often caused by iron deficiency.