OB Exam 2 Review Cards

what is the decidua basalis?

part of the endometrium that provides nutrients to the developing fetus

what causes enlargement of the uterus during pregnancy?

• high levels of estrogen and progesterone in the first trimester

• increased vascularity and dilation of blood vessels

what size is the uterus at 7 weeks?

hen’s egg

what size is the uterus at 10 weeks?

orange

what size is the uterus at 12 weeks?

grapefruit

after the 3rd month, what causes uterine enlargement?

mechanical pressure of the growing fetus

where is the uterus palpated between the 12th and 14th weeks of pregnancy?

palpated above the symphysis pubis

at 12 weeks, the uterus goes from the _____ into the _____ cavity.

pelvis; abdominal

at 20 to 22 weeks of gestation, the uterus rises to the ______.

umbilicus

at term, the uterus is nearly at the ______.

xiphoid process

At 12 weeks, the uterus goes from ____ shape to ________ shape

pear; spherical or globular

what is Hegar's sign?

softening and compressibility of the lower uterine segment during the first 3 months

what does Hegar’s sign cause?

• exaggerated uterine anteflexion that causes uterine fundus to press on bladder uterine

when can Braxton Hicks contractions be felt?

after the 4th month of pregnancy

what does maternal supine position do to blood flow?

DECREASE blood flow (supine position causes uterus to compress aorta and vena cava)

oxygen consumption _______ most during the last trimester.

increases

what is used to measure uterine blood flow velocity?

ultrasound doppler

what is lightening?

• “dropping” of baby into pelvis to prepare for delivery

• occurs between 38-40 weeks

what is round ligament pain?

• sharp/pulling pain in the groin region

• bands of tissue supporting uterus stretch quickly during sudden movements like rolling over, standing up, or coughing

what is balottement?

passive movement of the fetus felt by the examiner 16-18 weeks

how does an examiner feel for balottement?

• examiner places a finger within the vagina and taps gently upward on the cervix, causing the fetus to rise

• the fetus then sinks, and a gentle tap is felt on the finger

what is the first recognition of fetal movement?

quickening

when is quickening felt in nulliparous women?

week 18

when is quickening felt in multiparous women?

14-16 weeks

what is nulliparous?

woman who has never given birth to a live child

what is multiparous?

woman who has given birth 2+ times

what is nulligravida?

woman who has never been pregnant

what is primiparous?

woman who has given birth once

what is Goodell sign?

softening of the cervix tip at 6 weeks

what causes Goodell sign?

• increased vascularity

• slight hypertrophy

• hyperplasia

what is friability?

tissue of cervix is easily damaged and may bleed after sex

what is the operculum of the cervix?

• hyperactive mucus secretion forms mucus plug in early pregnancy

• rich in immunoglobulins and acts as a barrier against bacteria

what is Chadwick sign?

increased vascularity leads to blue tint on cervix

what prevents menstruation during pregnancy?

FSH and LH suppressed by estrogen and progesterone— amenorrhea

what hormones are secreted by the ovaries during the first 14 weeks of pregnancy?

estrogen and progesterone

_____ produced by ______ maintains estrogen & progesterone after 6-10 weeks.

hCG; placenta

what causes leukorrhea of the vagina?

• increase in lactobacillus and decrease in anaerobic bacteria

• results in lower pH 3.5-6

what is leukorrhea?

vaginal discharge

what symptoms arise from cytolytic vaginosis?

• similar symptoms to candidiasis — burning, white discharge, pruritus

what causes cytolytic vaginosis?

too much acidity (from discharge) that breaks down vaginal cell walls

what happens to nipples during pregnancy?

enlarge and become erect (blood vessels underneath nipples dilate from rich blood supply)

what happens to areolas during pregnancy?

enlarge and both become more pigmented

what are striae gravidarum?

stretch marks that appear on breasts during pregnancy

what do Montgomery tubercules secrete?

lubricating and antiinfective substances to help protect the nipples and areolas during breastfeeding

______ stimulates growth and proliferation of ______ for lactation.

estrogen; milk ducts

______ causes growth and development of the _________ for lactation.

progesterone; mammary lobes

what does colostrum begin to come from the breasts?

16th week

_______ stimulates colostrum by the end of the _____ trimester.

prolactin; first

what hormones stimulate development and differentiation of alveolar epithelial cells into lactocytes?

• prolactin

• progesterone

• human placental lactogen

________ is inhibited until the ________ level decreases after birth.

lactation; progesterone

what could be causes of nausea during pregnancy (morning sickness)?

• hCG

• estradiol in early pregnancy

• psychological predisposition

• evolutionary adaptation to protect the fetus and woman from potentially dangerous foods

morning sickness first appears at _______ weeks.

4-6

morning sickness peaks at ____ weeks.

9

morning sickness subsided by the end of the _______.

first trimester

what causes the gums to bleed easily/become hyperemic during pregnancy?

increased estrogen and vascularity

what is pica?

• altered tastes and cravings for nonfood items

• may be a factor of iron deficiency anemia

what is epulis?

• red, raised nodule on the gums that bleeds easily

• use a soft bristle toothbrush

what is ptyalism?

• excessive salivation caused by the unconscious decrease in swallowing by the woman when nauseated OR

• caused by stimulation of salivary glands by eating starchy foods

what causes reflux during pregnancy?

increased progesterone that causes decreased tone + motility of smooth muscles

what does smooth muscle relaxation cause?

• increased water absorption and constipation

• may also get hemorrhoids that can bleed when straining

what is pyrosis?

• heartburn beginning as early as the first trimester and intensifying through the third trimester

what causes pyrosis in pregnancy?

• relaxation of cardiac (lower esophageal) sphincter

• caused by growing fetus putting pressure on abdomen

what causes hiatal hernia in pregnancy?

• upward displacement of the stomach by the enlarging uterus

• more often in multiparous women, obese, or older

what factors contribute to gallstones?

increased emptying time and thickening of bile

the _______ is distended during pregnancy due to _______ muscle tone.

gallbladder; decreased

serum ________ and _______ levels are decreased during pregnancy.

albumin; protein

what causes an increase in venous pressure in the pelvic organs during pregnancy?

• displacement of intestines

• pressure from the expanding uterus

how much does blood volume increase during pregnancy?

increases 40-50% (1200-1500mL)

when does blood volume reach its peak during pregnancy?

peaks at 28-34 weeks

functions of increased blood volume during pregnancy

• meeting the blood volume needs of the hypertrophied vascular uterus

• hydrates fetal and maternal tissues when the woman assumes an erect or supine position

• compensates for blood loss during birth and postpartum

the heart _______ during pregnancy because of increased ______ and cardiac output (CO).

hypertrophies; volume

why is the heart displaced during pregnancy?

• enlarged uterus

• heart shifted upward

• HR increases 15-20 bpm

why does BP decrease slightly during pregnancy?

• reduced SVR (systemic vascular resistance) caused by vasodilatory effects of progesterone, prostaglandins, and relaxin

systolic BP during pregnancy

slight or no decrease from pre-pregnancy levels

when is SVR lowest during pregnancy?

16-34 weeks

diastolic BP during pregnancy

• slight decrease to mid pregnancy (24-32 weeks)

• gradual return to pre-pregnancy levels by end of pregnancy

pregnant women should not lay in which position?

• should not lay supine

• CO is reduced by as much as 25% to 30%

what position should a pregnant individual lay in to maintain proper blood flow?

left lateral recumbent position

what causes increased femoral venous pressure during pregnancy?

compression of the iliac veins and inferior vena cava by the uterus causes increased venous pressure and reduced blood flow in the legs

what can increased femoral venous pressure do to the body?

• edema

• varicose veins in the legs and vulva

• hemorrhoids — contribute venous thromboembolism (VTE)

• postural hypotension from blood stasis

what factors contribute to pregnancy being considered a hyper-coagulable state?

• INCREASE FIBRINOGEN (clotting factors 7-10) 30-50%, decrease chance of bleeding, but increase chance of thrombosis

• DECREASED FIBRINOLYSIS (factors that inhibit coagulation)

what is physiologic anemia of pregnancy?

• large increase in plasma volume, small increase in RBC size

  • causes dilutional decrease in hemoglobin + hematocrit

• causes increased need for Fe

what values are considered anemic in the 1st and 3rd trimesters?

• Hgb <11

• Hct <33%

what values are considered anemic in the 2nd trimester?

• Hgb <10.5

• Hct <32%

what is the earliest biologic marker for pregnancy?

hCG

presumptive signs of pregnancy

• subjective

• experienced by the woman: fatigue, breast changes, amenorrhea, quickening (first feeling of baby in the uterus)

probable signs of pregnancy

• objective

• changes perceived by examiner: pregnancy test, Hegar sign, Chadwick sign, Goodell sign, Braxton Hicks, ballottement, skin changes

what provides relief for round ligament pain?

• girdle

• warm compress/baths

• side lying w knees to abdomen

• ask provider for medication use

positive signs of pregnancy

• objective

• fetal heart tones, ultrasound

• indicate proof of pregnancy

what are Braxton Hicks contractions?

irregular, inconsistent, painless contractions between 4 months - birth

relief of Braxton Hicks contractions

• 1000-2000ml water/day

• girdle

• exercise or walking

• breathing

• resting

relief of leukorrhea

• reassurance of normalcy

• daily bathing

• cotton underwear

• wipe front to back

• no douching

what signs indicate abnormal leukorrhea?

• itching

• burning

• odor

• clumpy

• constant trickle

• bloody

relief of breast discomfort

• loose clothing so it doesn't rub against nipple

• well fitting supportive bra

• massage/heat

• good body mechanics/exercises to improve posture

• 3rd trimester leaking: soft cotton breast pads