OB normal pregnancy unit 2

striae gravidarum

• Stretch marks

• Dermis tears while the epidermis remains intact

linea nigra

line going down center of stomach on skin

chloasma

brownish patches on face

why do superficial blood vessels become more prominent during pregnancy

increased estrogen

what causes more hair growth and less hair loss in pregnancy

estrogen

is their hair growth or hair loss postpartum

hair loss

treatment for acne and pigment changes due to pregnancy

gentle cleansers and sunscreen/protect face from sun

treatment for dry skin and itching related to hormonal changes

• mild, moisturizing soap

• avoid overly hot water

• oral hydration

what thyroid disorders are at increased risk during pregnancy

hypo and hyperthyroidism

what semester does insulin need to start increasing

second

what adrenal hormone promotes lung and neurological development

cortisol

what adrenal hormone retains sodium and helps with plasma volume expansion

aldosterone

what pituitary hormone helps with milk production

prolactin

what pituitary hormone promotes uterine contractions

oxytocin

what pituitary hormone promotes milk ejection

oxytocin

respiratory alkalosis in pregnancy is caused by what

• CO2 diffusing from fetal circulation to maternal circulation

• O2 diffusing from maternal circulation to fetal circulation

why do ribs expand in pregnancy

to allow for an increase in oxygen consumption

what causes mucous membranes to be more vascular

increasing estrogen

how to treat shortness of breath in pregnancy

improve posture and light exercise

how to treat fatigue in pregnancy

encourage rest when possible

how to treat nasal congestion and epistaxis in pregnancy

• Saline nasal sprays

• Humidifiers

• Decongestants should be avoided

how much does cardiac output increase by during pregnancy

50%

what can an increase in cardiac output during pregnancy lead to

miner hypertrophy of the heart

how much does total blood volume increase by during pregnancy

40-45%

does RBC or plasma increase more in pregnancy

plasma - results in pseudoanemia

normal range for pregnancy Hematocrit

33-39

normal range for pregnancy Hemoglobin

11-13

how much do WBC increase during pregnancy

9-15%

why do clotting factors increase during pregnancy

to prevent excess bleeding

does BP increase or decrease at the beginning of pregnancy

decrease

normal heart murmur sounds during pregnancy

Split S1, systolic murmur, 3rd heart sound, diastolic murmur

what causes vena cava syndrome in pregnancy

uterus compressing the vein

how to treat postural hypotension in pregnancy

• avoid sitting or standing abruptly

• avoid lying in supine

is edema common during pregnancy

yes

how to treat edema during pregnancy

• Avoid standing or sitting for long periods of time

• Leg elevations

• Side lying for increased venous return

• Report sudden increase to provider, or unilateral leg edema

do varicosities increase or decrease later in pregnancy

increase

how to treat varicosities during pregnancy

• Avoid constipation

• Witch hazel

• Compression stockings

how much does blood flow increase through the kidneys during pregnancy

80%

how much does globular filtration increase during pregnancy

50%

is it uncommon for pregnant women to spill small amounts of glucose and protein into urine

no

urinary frequency/urgency during pregnancy

• Hormones, uterine changes, and increased blood flow to kidneys

• Do not limit fluid intake

• Symptoms of UTI

urinary incontinence during pregnancy

• 41% have urine leakage when sneezing, coughing, and laughing

• Kegel exercises

• Crossing legs before stress

does the nipple and areola darken or lighten during pregnancy

darken

from 16 weeks to 36 weeks, uterine centimeters should equal what

weeks gestation

hagar’s sign

softening of uterus

goodell’s sign

softening of vagina and cervix

chadwick’s sign

a bluish-purple discoloration of the cervix, vagina, and vulva

how to treat breast discomfort during pregnancy

• Wear supportive well fitting bra

• Sleep bra at night

• Breast pads

where are braxton hicks’ contractions felt

abdomen

when is vaginal discharge normal in pregnancy

when it occurs in the absence of bleeding, color change, odor, itching

lordosis

arch in lower spine - common in pregnancy

what causes in a decreased stability in ligaments and joints

progesterone and relaxin increase

diastasis rectus

a separation of the rectus abdominis muscle

ways to treat lower back pain in pregnancy

• Good lifting mechanics

• Pelvic rocking/tilts

• Physical therapy

ways to treat ligament pain in pregnancy

• Stretching exercises

• Bending forward when sneezing/laughing

ways to treat leg cramps in pregnancy

• Avoid plantar flexion

• Stretching-dorsiflexion of foot

• Massage

• Hydration

expected weight gain in a pre-pregnant underweight women

28-40 lb

expected weight gain in a pre-pregnant normal weight women

25-35 lb

expected weight gain in a pre-pregnant overweight women

15-25 lb

expected weight gain in a pre-pregnant obese women

11 to 20 lb

ways to treat nausea and vomiting in pregnant women

• Antiemetics

• B6 supplements and unisom

• Avoid triggers, smaller more frequent meals

• Acupressure, ginger

ways to treat tender/bleeding gums in pregnancy

• Soft tooth brush twice daily, flossing

• Routine dental checks

ways to treat increased salivation in pregnancy

• Sucking on hard candies

• Astringent mouthwash

ways to treat heartburn in pregnancy

• Avoid fatty foods

• Avoid laying down after meals (do not eat 3 hours before sleep)

• Smaller more frequent meals

ways to treat constipation in pregnancy

• Increase fiber in diet

• Stool softeners

• Good hydration

• Avoid caster or mineral oil

ways to treat gall stones in pregnancy

• Low fat diets

• Medication and possible surgery may be needed

ways to treat carpal tunnel syndrome in pregnancy

• Wrist splints

• Ice, massage

• Avoid repetitive tasks

ways to treat headaches in pregnancy

• Rest, proper posture, stress reduction

• Minimal meds

• Notify providers for sudden onset of severe headache with vision change

when is a headache concerning during pregnancy

after 20 weeks

ways to treat vision changes in pregnancy

• Eye drops

• Glasses instead of contacts

• Report sudden changes in vision

overview schedule of prenatal care

• (average of 12-16 visits)

  • 1st visit sometime in the first trimester

  • After that visits are monthly until the 28th week.

  • Every 2 weeks until 36 weeks

  • Weekly until end of pregnancy

lay midwife

a person who provides prenatal care and delivers babies without professional medical training or certification

nurse midwife

a registered nurse who has specialized training in midwifery

doula

a woman, typically without formal obstetric training, who is employed to provide guidance and support to a pregnant woman during labor

first trimester physical exam

• BP

• Height and weight

• Uterine size

• Heart tones

first trimester physical exam labs and imaging

• PAP if due

• Hcg

• Ultrasound if dates are unclear or don’t match fundal size

• Rh(D) factor screening/antibody screen

  • Negative or positive part of the blood type

• Genetic screening

• Rubella and varicella immunity

• HIV, Hep B and C, syphilis, STIs

Naegele's rule

• Last menstrual period - 3 months + seven days

some foods to avoid during pregnancy

• foods with high mercury levels

• raw or undercooked foods

• foods with listeria risk

• foods with high caffeine levels

• alcohol

pregnancy education: bathing

Avoid too hot of water for too long

pregnancy education: travel safety

• Seat Belt below abdomen

• Avoid flying in 3rd trimester

second trimester monthly appointments

• Review internal history, vitals, weight, fetal heart rate, fundal height, fetal activity

second trimester appointment routine labs

• Urinalysis: glucose or protein spillage

• Diabetes screening

• Rh factor screening

glucose challenge test

• 1 hour glucose screening

• Do not need to be fasting

• Drink 50 g of sugar

• Blood is drawn 1 hour after injections

• Above 130 indicates the need for 3 hour

glucose tolerance test

• Fasting

• Drink 100g of sugar

• Blood is drawn as fasting (<95), 1 hour (<180), 2 hours (<155), and 3 hours (<140)

• If 2  are above normal = gestational DM

amniocentesis diagnosis test

• Ultrasound guided needle removes amniotic fluids

chorionic villus sampling

• Removal of small portion of the chronic villi of the placenta

• Looks for genetic conditions

• As early as 10 weeks

• Risks: bleeding, fetal loss

third trimester visit routine lab tests

• Hemoglobin and hematocrit

• STI testing

• Group B strep screening

when to seek care

• Leakage of fluid from vagina

• Vaginal bleeding

• Reduced fetal activity

• Headache that does not improve with acetaminophen

• Right upper quadrant pain

• Vision changes

• Persistent contractions

• New onset lower back pain

• Sensation of pelvic pressure

• Menstrual like cramps

• Dysuria

pregnancy education: environmental hazards

• Teratogenic medications

• Excessive heat

• Workplace hazards

• Cat litter boxes

• Insect borne illnesses

• Air pollution