OB Final - New Topics

Ch. 4, 5, 6, 7

Reproductive system changes during pregnancy

• increased estrogen and progesterone levels

• prolactin levels increase

• vaginal area gets more acidic, may lead to yeast infections

• amenorrhea = still having period while pregnant

Cardiovascular and respiratory changes during pregnancy

• blood volume increases

• metabolic rate increases — mom needs more calories

• anemia

• don’t put mom flat on back → makes baby put pressure on spinal cord → O2 can’t get to brain, heart, and lungs fast enough → supine hypotensive syndrome

• decreased iron

• dependent edema

Renal and GI changes in pregnancy

• increased risk of UTI

• increased urinary output and frequency

• n/v

• heartburn → provide small, frequent meals

• bloating, flatulence, and constipation → prevent → after eating, walk around and no not lay down after eating

Musculoskeletal Changes

• “my insides are tearing apart” → internal tissue tearing → recommend a belly band

• round ligament spasm = smooth muscle is relaxing

• diastasis recti = stretching of rib area

• increased lordosis and risk of falls

integumentary changes

• linea nigra = hyperpigmentation line from under breast to pubic bone

• melasma (cholasma) = hyperpigmentation on face

• increased pigmentation of nipples, areola, vulva, scars, and moles

• increased perspiration

• striae gravidarum = stretch marks on abdomen, breasts, hips, and thighs

• varicosities = swollen, twisted veins seen under skin surface

• spider nevi = lesions that look like red spiders

• palmar erythema = red palms

Endocrine changes

• increased progesterone, estrogen, prolactin, oxytocin, human chorionic gonadotropin (hCG; normal is 600, but for twins normal is 1500. this helps thicken uterine lining to support fetus and tell body to stop menstruating)

• increased glucose → causes large baby

what cat care can a pregnant woman not do?

scoop cat litter

Nutrition and Exercise

• look at nutrition in book

Obesity increases risk of: (3)

• complications during pregnancy/delivery

• increased risks to the child → take extra folic acid! this decreases risk of NTD

• postpartum risks

presumptive signs

subjective → patient is telling the nurse a sign of pregnancy

• can possibly be related to something else

probable signs

objective

positive signs

signs only attributed to fetus

• Hedger - softening of (? - look in book for cervix or uterus)

• Chadwick - blue cervix (? - look at booklet)

• Goodell - (? - look in book for cervix or uterus)

due date calculation !

Naegele’s rule = last menstrual period → - (minus) 3 months + 7 days

ultrasound used to observe

Gravida/Para

G = total number of times pregnant

T = number of term infants born after 37 weeks

P = number of preterm infants born less than 37 weeks

A = number of abortions (less than 20 wk)

L = # current living children

G = pregnancies

P = live births after 20 wk

prenatal care: mom goes to clinic how often in the first trimester? second? third?

1 - once a month/every 4 wk

2 - twice a month/ every 2 wk

3 - every week

1st trimester prenatal care: what is an important lab test?

glucose test

tests for gestational diabetes, expected finding is negative

1st trimester prenatal care: assessment, lab tests (glucose), patient education, common discomforts, relief measures, danger signs

Suggested weight gain = 1-4 lbs total

confirm and date pregnancy

verify intrauterine pregnancy

detect fetal cardiac activity

measure nuchal translucency (if too thick (3mm) → down syndrome)

detect pelvic abnormalities

2nd trimester prenatal care: lab tests, assessment, patient education, common discomforts and relief measures, danger signs

booklet

3rd semester prenatal care: lab tests, assessment, pt educations, common discomforts, danger signs

booklet