Quiz 1 Study Guide

GI adaptations to pregnancy

• Patients appetite can increase as long as they are not experiencing morning sickness by 15-20%

• Increased estrogen

• Bad breath

• Gums

• Ptyalism

• Dental problems

• Decreased peristalsis and smooth muscle relaxation due to increased estrogen and sphincter tone decrease due to uterus growing and pushing everything up, causing gastric acid to come up (reflux)

• Constipation + increased venous pressure + pressure from the uterus = hemorrhoids

• Slowed gastric emptying, increasing heart burn

• Prolonged gallbladder emptying

• Nausea and vomiting

• Interventions

• Cavities

GI adaptations to pregnancy: increased estrogen

• Can cause gums to bleed due to increased vascularity 

GI adaptations to pregnancy: ptyalism

• increased salivation

GI adaptations to pregnancy: dental problems

Gingivitis

GI adaptations to pregnancy: decreased peristalsis

• Stomach gets pushed up and out of place

• Progesterone causes muscle to decrease and relax slowing GI motility

GI adaptations to pregnancy: hemorrhoids

Constipation + increased venous pressure + pressure from the uterus

GI adaptations to pregnancy: prolonged gallbladder emptying

• Uterus growing pushes liver altering function due to shifting of placement

• Retain bile salts causing pruritus

GI adaptations to pregnancy: interventions

• Chewing gum

• Throat lozenges 

GI adaptations to pregnancy: cavaties

• Increased salivation or n/v causes cavity/tooth decay predisposition

• Infection can predispose going into preterm labor

GTPAL stands for

• Gravida

• Term

• Preterm

• Abortion

• Living

GTPAL: Gravida

• All pregnancies

• “How many times, including this pregnancy, have you been pregnant?”

• ALWAYS COUNT CURRENT PREGNANCY

GTPAL: Term

• Pregnancies delivered after 37 weeks gestation

• “How many babies were born at term”

GTPAL: Preterm

• Any pregnancy delivered before 37 weeks gestation

• “How many babies were born before term”

• Anything from 20 weeks to 36.6 weeks

GTPAL: Abortion

• Any loss prior to 20 weeks either induced or spontaneous

• From conception to 19.6 weeks

GTPAL: Living

• All living children

• Amount of living children at time of taking health history

TPA & gravida number

• TPA

  • should be 1 below gravida

what is EDC

• Estimated date of confinement

  • When is it done

• Determined using Nagele’s rules

  • Estimates due date

How to EDC

• Use first date of last menstrual period

  • 11/21/22

    • Subtract 3 months

  • 8/21/22

    • Add 7 days

  • 8/28/22

    • Add 1 year if needed

  • 8/28/23

Presumptive signs of pregnancy

• Fatigue

  • From changes in hormones such as progesterone levels

• Breast and tenderness

• Nausea/vomiting

• Amenorrhea

• Urinary frequency

• Hyperpigmentation of skin

• Quickening

• Breast enlargement

• Chadwick wign

Presumptive signs of pregnancy: chadwick sign

Cervix changes color from pink to blue/purple due to increased blood flow and vascularity to the cervix from pregnancy

Probable signs of pregnancy

• Braxton hicks contractions

• Positive pregnancy test

  • Can be inaccurate

• Abdominal enlargement

• Ballottement

• Goodell sign (ch 6 pg 107-108)

• Hegar sign (ch 6 pg 107-108)

• Palpation of fetal outline

• Uterine souffle

Probable signs of pregnancy: goodell sign

• Lower segment of uterus and cervix have become soft tissue due to increased hormones in that area

Probable signs of pregnancy: hegar sign

• Softening of the lower segment of the uterus between the cervix and uterus and where they meet due to hormonal changes

Positive signs of pregnancy

• Ultrasound image of fetus

• Fetal movement felt by clinician

• Auscultation of heart tones by doppler

Non stress test

• Provides an indirect measure of utero-placental function

• It is a noninvasive test that requires no initiation of contractions

• Quick to perform (20 min) and there are no known SE or risks

• 2 results

  • NST results are interpreted as reactive or nonreactive

Non stress test: reactive NST

• Includes at least 2 fetal heart rate accelerations from the baseline of at least 15-bpm (beats per minute) for at least 15 seconds in duration within a 20 minute recording period

• Good, perfect, beautiful 

  • Within 20 min

  • 2 accelerations

  • 15 bpm above baseline

  • Lasts 15 seconds

Non stress test: Non-reactive NST

• Characterized by the absence of 2 fetal heart rate accelerations using the 15-by-15 criterion in a 20 minute time frame

• Might be a problem

• If we have 1, we can allow another 20 minutes

  • Within 40 minutes we don't have at least 2 accelerations and must go for biophysical profile

What if the NST is nonreactive?

• A nonreactive test has been correlated with a higher incidence of fetal distress during labor, fetal mortality, and IUGR (intrauterine growth restriction)

  • If an NST is nonreactive, a biophysical profile will be ordered to investigate further

Ultrasound in pregnancy

• First trimester

  • transvaginal

• Second trimester

  • abdomen

• Third trimester

  • abdomen

• doppler flow studies

Ultrasound in pregnancy: first trimester

• visualize the pregnancy for confirmation

• identify and ectopic pregnancy

• confirm a molar pregnancy

• & confirm cardiac function in the pregnancy. 

• Threatened miscarage

• No heart beat or is a heart beat

Ultrasound in pregnancy: second trimester

• Usually around 18-20 weeks

• Looks for congenital malformations

• Multifetal pregnancies

• Verify dates and growth

• amniotic fluid

• Blood flow to placenta

• placenta

Ultrasound in pregnancy: third trimester

• About 34 weeks 

• Used to evaluate fetal size, fetal growth, or to guide amniocentesis

• Complications in pregnancy

Ultrasound in pregnancy: doppler flow studies

• Used to examine the flow of blood in blood vessels

• Comprehensive assessment of fetal well being involves

  • Monitoring of fetal growth

  • Placental function

  • Central venous pressure

  • Cardiac function

Umbilical cord

• Formed as a connection from mom to fetus through the placenta

• Formed from the amnion when the placenta is forming at the end of 2nd week gestation

• Lifeline between the mother and fetus

• Covered in whartons jelly for protection

  • Protects from compression

• Contains 1 large vein and 2 small arteries

• At term, the cord is appx 22 inches long and 1 in wide

• Function

  • Carries oxygenated blood to the baby (vessels), carries deoxygenated blood away from the baby (arteries) using different vessels in the cord

• Lifeline between mom through placenta and baby

Fetal circulation

• Fetal shunts

  • Frayman ovalley

  • Ductus arteriosus

  • Ductus venosus

Fetal circulation: frayman ovalley

• Shunt between right and left side of heart

• At the junction between right and left atrium

  • Right side of fetal heart has more pressure than the left vs in adults (more pressure in left in adults)

    • This pressures pushes the septum in between the right and left atrium open to get blood into the left atrium, doorway that opens and closes from the pressure of the right side of the heart

Fetal circulation: ductus arteriosus

• Connects aorta with pulmonary artery and shunts blood AWAY from the lungs into the aorta to be circulated throughout the system

Fetal circulation: ductus venosus

•  Located just outside the liver and shunts blood away from the liver bc its non-functioning to circulate throughout the rest of the body

what is oligohdydraminos

• Not enough amniotic fluid

• Abnormally low amount of amniotic fluid (less than 50% of the amount expected for gestational age or under 400 mL at term)

• May be associated with

  • Poor placental blood flow

  • Low birth weight infants

  • Failure of fetal kidney development

  • Blocked urinary excretion

  • Poor fetal lung development

• Can also be associated with congenital anomalies related to kidney function

what is polyhdydraminos

• Too much amniotic fluid

• An abnormally high amount of amniotic fluid that may exceed 2000mL

• May be associated with

  • Imbalance water exchange among mother, fetus, and amniotic fluid that has no known cause

  • Poorly controlled maternal diabetes mellitus resulting in large quantities of fetal urine excretion having an elevated glucose level

  • Malformation of the GI tract that interferes with the normal fluid ingestion, metabolism, and excretion

Function of the placenta

• Formed after implantation

• Main component of pregnancy hormones

• Serves as interface between mother and fetus

• Makes hormones to control physiology of the mother to ensure the fetus is supplied with nutrients and oxygen needed for growth

• Removes waste products from the fetus

• Produced hormones - which are all necessary for a normal, healthy pregnancy

• Filters things out

• Helps with oxygenation

• Brings nutrients to baby

• Exchanges waste products

• Beefy part

  • Attached to uterus

• Smooth part

  • Out towards baby

• Gestational illness can come from placenta, goes away when baby is born

What hormones does the placenta produce

• chorionic gonadotropin

• Prolactin

•  Estrogen

• Progesterone

• HCS

• Relaxin 

Simplified functions of placenta

• Functions as liver, lungs, kidneys all in one

• Controls hormone production maintaining pregnancy

• Gives nutrients and vitamins from moms blood system to the fetus

Prenatal lab tests include

• Urinalysis

• CBC

• Chem profile

• Blood type & rH factors

• Rubella titer

• Hepatitis B

• HIV

• VDRL

• RPR

What is implantation

• Implantation occurs in the upper uterus

  • Uterus is richly supplied with blood for optimal fetal gas exchange, nutrition, and waste elimination, the lining is thick, preventing the placenta from attaching too deeply and limits blood loss after birth

  • Implantation

    •  usually occurs between 6-10 days after conception/fertilization

    • Can bleed, egg is embedding itself into lining

      • Around day 2-3

      • Spotting

      • May not know for 8 weeks we are pregnant (COOKED)

Urinary adaptation to pregnancy

• Increase in frequency and urgency

  • Can be s/s of bladder infection → educate

  • Bladder capacity doubles by the time pt is full term

  • Tone is decreased due to progesterone relaxing smooth muscle

  • End of pregnancy the uterus is pressing it on the bladder and pushing it out of place increasing urinary frequency and leaking

  • Can retain up to 300mL of urine aka urinary stasis → most common cause of bladder infections

• Influenced by hormonal changes

• Renal plasma flow increases by 50-80% to help excrete metabolic waste from fetus

• Urinary output increases

Fetal growth and development first 12 weeks

Fetal growth and development first 12 weeks: week 1

Fetal growth and development first 12 weeks: week 2

Fetal growth and development first 12 weeks: week 3

Fetal growth and development first 12 weeks: week 4

Fetal growth and development first 12 weeks: week 5

Fetal growth and development first 12 weeks: week 6

Fetal growth and development first 12 weeks: week 7

Fetal growth and development first 12 weeks: week 8

Fetal growth and development first 12 weeks: week 9

Fetal growth and development first 12 weeks: week 10

Fetal growth and development first 12 weeks: 11

Fetal growth and development first 12 weeks: week 12