Maternity Unit 1

1st trimester (length)

day of last menstrual period - 13 weeks

2nd trimester (length)

14-27 weeks

3rd trimester (length)

28-40 weeks

Term pregnancy is considered how many weeks?

37 weeks or more

Preterm pregnancy is considered what? (length)

20-36 weeks 6 days

Abortion (time period) in regard to GTPAL

pregnancy loss before 20 weeks

GTPAL stands for

Gravida, Term, Preterm, Abortion, Living children

Gravida

# of pregnancies including the current one

What is the earliest biochemical marker for pregnancy?

hCG

Abnormally low or slow increase of hCG may indicate

Impending miscarriage or an ectopic pregnancy

Higher than average levels of hCG may indicate

abnormal gestation or multiple gestations

Presumptive signs of pregnancy

subjective signs felt by the women that suggest possibility of pregnancy

Examples of presumptive signs of pregnancy

N + V, Fatigue, breast change, amenorrhea (no period), urinary frequency, and quickening

Quickening

women feels the fetus move (usually around 16-20 weeks)

Probable signs of pregnancy

objective changes observed by examiner that strongly suggest pregnancy

Examples of Probable signs of pregnancy

Positive Pregnancy test, Goodell sign, Chadwick sign, Hegar sign, Braxton hicks, and Ballottement

Goodells sign

Softening of the cervix

Chadwick Sign

Bluish discoloration of cervix due to increased vascularity

Hegar Sign

Softening of the lower uterine segment

Braxton hicks

Mild menstrual-like cramps or a feeling of stretched skin

Sporadic uterine tightening sensation

Ballottement

Where a healthcare provider taps the uterus and feels the fetus float away and rebound back against their finger

Positive signs of pregnancy

Objective changes that prove pregnancy exists

Examples of Positive signs of pregnancy

Fetal heart sounds, Ultrasound, fetal movement felt by examiner

Leukorrhea

White discharge from the vagina

Main changes of the cardiovascular system in pregnancy

Increased blood volume

Increased cardiac output can cause

Heart enlargement which can cause a murmur

True or False? - Arrhythmias can be common with pregnancy

True

Why does edema in the legs occur with pregnancy?

Compression on the iliac veins, decreases blood return from the legs

Altered blood flow to and from the legs puts someone high risk for

DVT

Lying on the back when pregnant can cause

Supine hypotension

What are some interventions for supine hypotension?

have patient lie on their side

Pregnancy anemia

Plasma exceeds RBS production which causes increased plasma and decreased hgb and hct

Pregnancy Anemia levels

hgb < 10.5

hct < 32%

Respiratory adaptions of pregnancy

SOB, Chest breathing, O2 requirements increase

In pregnancy, respiratory rate

does not change

Common respiratory symptoms of pregnancy due to increased blood flow

Stuffiness, Nose bleeds, voice changes, increased inflammatory response

GI adaptions to pregnancy

morning sickness, changes in sense of taste, swollen gums that bleed easy, reflux, heartburn, and constipation

In pregnancy there is a _______ in smooth muscle tone.

decrease

Lordosis

Curvature of the spine

Hyperpigmentation

Darkening areas of the skin (nipples, areolae, axillae, vulva)

Melasma

aka chloasma or mask of pregnancy

blotchy, brownish hyperpigmentation of the skin over cheeks, nose, and forehead

Linea Nigra

Dark vertical line up the center of the stomach during pregnancy

Striae Gravidarum

Stretch marks

Angiomastas

“Vascular spiders” often on the breasts,

due to increased blood flow to the skin due to the rising estrogen levels during pregnancy

Progesterone

hormone that maintains pregnancy- prevents miscarriage

Prolactin

prepares the breasts for breastfeeding

oxytocin

natural hormone that causes contractions

Pitocin

Synthetic oxytocin that stimulates contractions

Initial visit with the OB (1st trimester)

Medical hx, OBGYN hx, nutritional history, medication use (including OTC), physical exam, labs, and risk assessment

Age that are considered high risk for pregnancy

Less than 19

Greater than 35

Hyperemesis Gravidarum

Excessive vomiting during pregnancy that causes weight loss, electrolyte imbalance, nutritional defiances, and ketones in the urine

Interventions for Hyperemesis Gravidarum

admission to receive fluids for imbalances and medications for nausea and vomiting

Diclegis

medication given for nausea and vomiting and morning sickness during pregnancy (antihistamine + b6)

How much weight is considered normal for a pregnant woman to gain during pregnancy?

25-35 lbs

IUGR

intrauterine growth restriction

Pica

Cravings and or attempting to eat nonedible things

Pica is often caused by

Low iron, hgb, or hct

Why is folic acid needed with prenatal care

helps to prevent neural deficits for the baby

Poor nutrition during pregnancy can cause

IUGR and preterm labor

4 Components of the Maternal physical exam

vital signs, head to toe, FHT, and vaginal exam

What is observed in the head-to-toe assessment in regard to the uterus

Uterine size/ fundal height

3 ways to estimate gestational age

naegele’s rule, fundal height, and ultrasound

After 20 weeks the general rule for fundal height is

1 cm= 1 week

How to do Naegeles rule

1st day of LMP.

Minus 3 months,

Add 7 days,

Add 1 year

Fundus

top of uterus

Oligohydraminos

Low amniotic fluid

Polydraminos

increased amount of amniotic fluid

Hemolytic disease

when moms blood attacks the baby’s blood (depending on blood types)

ABO

Mom is O; baby is something else

Rh

Mom is negative; baby is something else

When is Rhogam used

When moms blood type is Rh negative

When is Rhogam given

28 weeks, within 72 hours of birth, trauma, ectopic, miscarriage, chorionic villi sampling, percutaneous umbilical sampling, and amniocentesis

Tx for ABO incompatible pregnancy

bilirubin checked and light therapy for jaundice

Direct antibody testing

checked at birth via the umbilical cord and is checking baby’s blood for Rh status

What does direct antibody testing tell us

if baby is high risk for jaundice (higher number= higher risk)

Quad screen/Multiple Marker Screens

Blood test that can be done around 15-22 weeks to check for genetic disorders for those that are high risk.

It does not give diagnosis it allows for early detection

Ultrasounds help to identify

placement of fetus, fetal growth, number of fetuses,

gestational age, placental placement, congenital abnormalities, and overall fetal wellbeing

Chorionic Villi Sampling (CVS)

Genetic study done in the 1st trimester- placenta biopsy to check fetal cells

Percutaneous Umbilical blood Sampling

Done in the 2nd and 3rd trimester

Fetal blood sampling from the umbilical cord.

Checks for genetic issues for anemia or thrombocytopenia

Non stress Tests (NST)

Checking of fetal movements and reactions by fetal heart rate

What is considered good for non stress test for fetal HR

2 accelerations in a 20 minute window

If non stress test is reactive

baby HR is accelerating (meaning good)

Contraction stress test

induced contractions to see how the baby responds

How do they induce contractions for a contraction stress test

Pitocin or natural oxytocin stimulation (nipple stimulation)

What is a positive contraction stress test

Fetal HR drops

What does a biophysical profile consist of

non stress test, ultrasound, fetal movements, fetal tone, fetal breathing movements (each worth up to 2 points)

Normal score for the biophysical profile

8-10

If the biophysical profile is low, what may need to happen

labor may be induced

Incomplete miscarriage

not all passed through

Early pregnancy bleeding may indicate

miscarriage

Late pregnancy bleeding may indicate issues with

the placenta

Placenta Previa

abnormal implantation of the placenta

at the lower part of the uterus and or above the cervix

Placenta abruption

placenta comes off/detaches from the uterine wall causing internal bleeding

S/S of placenta previa

red vaginal bleeding, little to no pain or tenderness, normal fetal HR

Nursing interventions for the fetus with placenta previa/abruption (when mom is stable)

give corticosteroids to help fetal lung development

Nursing interventions for placenta previa

ultrasound- this may fix itself- continue to monitor, bed rest, nothing by vagina, may need c section depending on the degree

Placenta Abruption is considered a

medical emergency

S/S of placenta abruption

usually late in labor/3rd trimester, uterine tenderness, abdominal pain, abnormal FHR, dark red bleeding

Tx for Placenta abruption

constant monitoring, bed rest, stat ultrasound, give IV fluids, give blood products, monitor blood loss, prepare for c-section