OB Lecture Exam 2 & Terminology

ch. 5 (violence against women), ch. 13 (A&P of pregnancy), ch. 14 (nursing care of the family during pregnancy), ch. 15 (maternal nutrition), ch. 26 (assessment of HR pregnancy), ch. 27 (hypertensive disorders), ch. 28 (hemorrhagic disorders), ch. 29 (endocrine & metabolic disorders)

ch. 13 (uterus during pregnancy) - alters size, shape, and position; Hegar sign indicates softening of the lower uterine segment by 6 weeks

uterine growth

ch. 13 - increased blood flow & contractility lead to Braxton Hicks contractions; fetal-related changes include ballottement & __________

quickening (first movements perceived by the pregnant woman)

ch. 13 (cervix during pregnancy) - the cervix remains firm and closed; __________ develops from increased vascularization

Goodell sign (softening of the cervix during early pregnancy)

ch. 13 (ovaries during pregnancy) - ovarian ovulation ceases; __________ produces hormones that support amenorrhea in early pregnancy

corpus luteum

ch. 13 (vagina during pregnancy) - __________ appears; hormonal changes increase leukorrhea and lower vaginal pH

Chadwick sign (blue discoloration of vaginal and pelvic mucosa)

ch. 13 (vulva during pregnancy) - __________ pelvic blood flow and uterine pressure cause vulvar edema and varicosities

increased

ch. 13 - __________ from plasma volume increase leads to physiologic anemia; Hgb <11 g/dL or <10.5 g/dL is diagnostic

hemodilution

ch. 13 - pregnancy increases O₂ consumption and thoracic expansion, while respiratory rate stays unchanged

structural and pulmonary changes

ch. 13 - include nausea (from hCG), reflux, constipation, pica, gum bleeding, increased salivation, slower digestion, and higher gallstone risk

pregnancy GI effects

ch. 13 - pregnancy increases kidney size, GFR, and urine flow time; bladder irritation and urine glucose/protein spillage may occur

renal adaptation and function

ch. 13 - pregnancy skin changes include hyperpigmentation (chloasma, linea nigra), stretch marks, and abdominal itching

skin changes

ch. 13 - pregnancy affects the musculoskeletal system with lordosis, joint laxity, widened symphysis pubis, waddling gait, leg cramps, and fall risk

effects of pregnancy on musculoskeletal

ch. 13 - pregnancy may cause headaches, carpal tunnel, corneal changes, and increased thyroid, prolactin, and insulin levels

neurologic and endocrine systems

ch. 13 - stimulates enlargement of breasts and uterus; relaxes pelvic ligament and joints

estrogen

ch. 13 - suppresses FSH & LH; facilitates implantation and decreases uterine contractility

progesterone

ch. 13 - stimulates corpus to secrete estrogen and progesterone until placenta is mature enough to do so

human chorionic gonadotropin (hCG)

ch. 13 - stimulates fetal growth by regulating available glucose and stimulates breast development

human placental lactogen (hPL)

ch. 13 - water-soluble protein secreted by corpus luteum; causes relaxations of symphysis; softens ligaments and cervix

relaxin

ch. 13 - secreted by anterior pituitary; prepares for lactation

prolactin

ch. 13 - produced by posterior pituitary; stimulates uterine contractions

oxytocin

ch. 13 - subjective signs (e.g., nausea, fatigue, missed period) felt by the woman

presumptive pregnancy

ch. 13 - objective signs (e.g., positive pregnancy test, uterine changes) observed by the examiner

probable pregnancy

ch. 13 - definitive signs (e.g., fetal heartbeat, ultrasound, fetal movement felt by provider)

positive pregnancy

ch. 14 - is calculated from the first day of the last menstrual period using Nägele’s Rule—subtract 3 months, add 7 days, and adjust the year

estimated date of birth (EDB)

ch. 14 - was is the EDB when the patient says the first day of her last menstrual period was december 21, 2024?

september 28, 2025

ch. 14 - what is the gravida & parity of a woman who had 3 pregnancies and normal deliveries, but the third was a twin birth?

G3; P3

ch. 14 - what does GTPAL stand for?

G - gravida

T - term

P - preterm

A - abortion

L - living

ch. 14 - J. D. is 8 weeks pregnant and is at her first prenatal visit. she has two children aged 9 delivered at 38 weeks and 4 delivered at 36 weeks. what is the GTPAL?

G - 3

T - 1

P - 1

A - 0

L - 2

ch. 14 - every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then weekly until birth

prenatal visits

ch. 14 - includes interview, full health and OB history, physical exam, lab tests, and education on pregnancy care, and nutrition

initial PNC visit

ch. 14 - include interview, vital signs, weight, urinalysis, physical exam, fundal height, fetal assessment, and ongoing teaching

PNC follow-up visits

ch. 14 - assessment includes asking direct questions, gaining the client’s trust, and interviewing the client away from their partner

intimate partner violence (IPV)

ch. 14 - follow ABCDES (alone, belief, confidentiality, documentation, education, safety) interventions

intimate partner violence (IPV)

ch. 14 - include CBC, blood type and Rh with antibody screen, urinalysis with culture, rubella titer, and STI panel (syphilis, HIV, hep B)

labs at PNC initial visit

ch. 14 - repeat CBC, syphilis, HIV, and hep B labs; screen for gestational diabetes, chromosomal abnormalities, and NTDs

28 week visit labs

ch. 14 - test for group B streptococcus and administer recommended immunizations including Tdap, hep B, and influenza

35-37 week visit labs & immunizations

ch. 14 - key topics such as nutrition, prenatal vitamins, and personal hygiene

self-management during pregnancy

ch. 14 - high-mercury fish (shark, swordfish, king mackerel), raw/smoked seafood, and unpasteurized dairy (soft cheeses)

foods to avoid during pregnancy

table 14.3 - what are the most common breast changes during pregnancy?

breasts feel heavy and full and areola darkening

table 14.3 - what are the most common skin discomforts during pregnancy?

pigmentation changes, acne, oily skin, spider nevi, and pruritus

table 14.3 - what are the most common musculoskeletal discomforts during pregnancy?

round ligament pain, joint pain, backache, pelvic pressure, and leg cramps

table 14.3 - what are the most common GI discomforts during pregnancy?

nausea and vomiting, ptyalism, gingivitis and gum bleeding, heartburn, constipation, and flatulence with bloating and belching

ch. 14 - is generally safe unless contraindicated; desire may fluctuate, positions may need adjusting, and open communication is key

intimacy during pregnancy

table 14.4 - what are five signs of potential complications in the first trimester of pregnancy?

severe vomiting, fever and chills, burning with urination, abdominal cramping, and vaginal bleeding

table 14.4 - what are five signs of potential complications in the second and third trimesters of pregnancy?

sudden fluid discharge from the vagina before 37 weeks, decreased fetal movement, severe backache, visual disturbances, and swelling of the face and fingers

ch. 14 - uterus becomes an abdominal organ; by 16 weeks, fundus is midway between symphysis pubis and umbilicus

13-16 weeks

ch. 14 - fundus reaches the umbilicus

20-22 weeks

ch. 14 - fundus rises from midway between umbilicus and xiphoid (26–28 weeks) to xiphoid process (36 weeks)

26-36 weeks

ch. 14 - fundal height ≈ gestational age in cm (±2 cm); 38–40 weeks: fundus may drop (lightening)

28-32 weeks

ch. 15 - based on prepregnancy BMI—25–35 lbs for normal weight, 28–40 lbs underweight, 15–25 lbs overweight, and 11–20 lbs obese

recommended gain

ch. 15 - 2–4 lbs in the first trimester, then ~1 lb/week; excessive gain may signal fluid retention or preeclampsia

weight gain pattern

ch. 15 - inadequate or excessive gain increases risk of preterm birth, small for gestational age, or complications like gestational diabetes and HTN

risks of poor gain

ch. 15 - focus on nutrient-dense foods, avoid empty calories, stay active, and do not diet—weight quality matters more than quantity

healthy habits

table 15.3 - calcium needs during pregnancy and lactation are 1000–1300 mg daily. what are sources of calcium?

milk, cheese, yogurt, sardines, and dark leafy greens

ch. 15 - may need supplements for calcium, iron, B12, and vitamin D

vegan pregnancies

ch. 15 - raw fish, unpasteurized dairy, and deli meats unless reheated to prevent foodborne illness

avoid

ch. 15 - good hygiene, wash produce, and cook foods thoroughly

practice

quiz 2 prep - as the clinic nurse, what instructions would you give to a group of pregnant women in preventing constipation? select all that apply.

a) perform regular exercises such as walking

b) take stool softeners as needed

c) increase green leafy veggies

d) consume 8-10 glasses of water daily

e) have 20 mL olive oil once a week

a. perform regular exercises such as walking

c. increase green leafy veggies

d. consume 8-10 glasses of water daily

rationale: pregnant women should prevent constipation by exercising regularly, eating high-fiber foods like leafy greens, and drinking plenty of water. stool softeners are not routinely recommended without a provider’s order. olive oil is not a standard or evidence-based remedy for constipation in pregnancy.

quiz 2 prep - a pregnant client visits the clinic for her first prenatal visit. her obstetric history includes 2 live births at term, 1 stillborn at term, and 1 miscarriage at 6 weeks. what is her GTPAL?

a) G4T3P1A1L2

b) G5T3P0A1L2

c) G5T3P1A1L3

d) G4T3P0A1L2

b) G5T3P0A1L2

rationale:

G (gravida) = 5 → 2 live + 1 stillborn + 1 miscarriage + 1 current

T (term) = 3 → all 3 babies were full-term

P (preterm) = 0 → no babies born between 20–36 weeks

A (abortion) = 1 → 1 miscarriage before 20 weeks

L (living) = 2 → only the 2 live births are living

quiz 2 prep - hormone produced by the placenta that relaxes smooth muscles during pregnancy

progesterone

gravida (G)

how many times a woman has been pregnant

nulligravida

a woman who has never been pregnant

primigravida

a woman who is pregnant for the first time

multigravida

a woman who has been pregnant more than once

parity (P)

how many pregnancies lasted 20 weeks or more

nullipara

a woman who has never carried a pregnancy to 20 weeks

primipara

a woman who has give birth once at 20 weeks or more

multipara

a woman who has give birth two or more times at 20 weeks or more

gestation

the time a baby grows in the womb—from conception to birth

antepartum

the time during pregnancy before labor begins

intrapartum

the period during labor and delivery

postpartum

the time after birth, usually the first 6 weeks

preterm

birth that occurs before 37 weeks of gestation

term

pregnancy between 37 and 42 weeks

post term

birth at or beyond 42 weeks

viability

ability of the fetus to survive outside the womb, usually at 24 weeks

stillbirth/stillborn

baby born without signs of life at or after 20 weeks

abortion/miscarriage

pregnancy loss before 20 weeks, either natural or induced

ch. 27 - SBP > 140 mm Hg or DBP > 90 mm Hg or both

HTN classification

ch. 27 - development of HTN after 20 weeks of pregnancy; woman was normotensive with no proteinuria

gestational HTN

ch. 27 - development of HTN and proteinuria after 20 weeks of pregnancy or in the early postpartum period

preeclampsia

ch. 27 - development of seizures or coma not attributable to other causes in a preeclamptic woman

eclampsia

ch. 27 - HTN in a pregnant woman present before pregnancy

chronic HTN

ch. 27 - chronic HTN in association with preeclampsia

superimposed preeclampsia

ch. 27 - starts with abnormal placental development, leading to poor perfusion and widespread endothelial dysfunction

preeclampsia

ch. 27 (preeclampsia) - causes vasospasm, increased BP, reduced organ perfusion, and plasma volume loss

placental ischemia

ch. 27 (preeclampsia) - kidney, liver, and brain are affected—resulting in proteinuria, __________, cerebral edema, and __________

elevated liver enzymes; seizures

ch. 27 (preeclampsia) - fluid shifts cause __________, edema, and serious complications like pulmonary edema or liver hemorrhage

hemoconcentration

ch. 27 - is identified by hemolysis, elevated liver enzymes, and low platelets, often without high BP or proteinuria

HELLP syndrome

ch. 27 - assess BP trends, proteinuria, reflexes, edema, and severe signs (headache, RUQ pain, vision changes)

preeclampsia

ch. 27 -  includes stabilizing ABCs, giving magnesium, assessing fetus and uterus, and planning delivery

post-eclampsia care

table 27.2 in pptx - BP ≥ 140/90 after 20 weeks, with proteinuria ≥ 300 mg/24 hr or protein/creatinine > 0.3

preeclampsia diagnostic criteria

table 27.2 in pptx - may include mild thrombocytopenia, elevated liver enzymes, or renal changes (creatinine > 1.1 mg/dL)

preeclampsia

table 27.2 in pptx - BP ≥ 160/110, with new cerebral/visual changes, pulmonary edema, or RUQ pain

preeclampsia with severe features

table 27.2 in pptx - platelets < 100,000, liver enzymes ≥ 2× normal, or creatinine > 1.1 mg/dL

preeclampsia with severe features

box 27.3 - magnesium prevents seizures, not BP; explain route, side effects (flushing, sedation), and need for close monitoring

teaching care of the woman with preeclampsia receiving magnesium sulfate

box 27.3 - administer via pump; monitor vitals, DTRs, urine, FHR; report RR <12, urine <30 mL/hr, neuro changes, or abnormal labs

care of the woman with preeclampsia receiving magnesium sulfate

ch. 29 - increased insulin sensitivity lowers maternal blood glucose, raising hypoglycemia risk

metabolic changes associated with the first trimester of pregnancy

ch. 29 - placental hormones cause insulin resistance, increasing insulin needs up to 4x; needs drop after birth

metabolic changes associated with the second and third trimesters of pregnancy

ch. 29 - diabetes results from impaired insulin secretion or action, leading to hyperglycemia

DM cause