Maternal Adaptation & Diagnosis Flashcards

NCLEX-style study flashcards focusing on maternal body-system adaptations, symptom etiology, pregnancy test modalities, and classification of pregnancy signs (presumptive, probable, positive).

How does the uterus adapt anatomically during pregnancy in terms of weight and tissue growth?

The uterus increases in weight from $50\,\text{g}$ to $1000\,\text{g}$ through hypertrophy and hyperplasia.

What is Goodell's sign and what physiological changes cause it?

Goodell's sign is cervical softening caused by increased vascularity, edema, and glandular hyperplasia.

What is Chadwick's sign and what causes it?

Chadwick's sign is a bluish appearance and increased vascularity of the vagina and cervix caused by estrogen.

What is Hegar's sign?

Hegar's sign is the softening of the lower uterine segment (isthmus).

How long does the corpus luteum produce progesterone before the placenta takes over?

The corpus luteum produces progesterone until approximately $10\text{–}12\,\text{weeks}$ of pregnancy.

What cardiovascular volume and cardiac output changes occur during pregnancy?

Blood volume increases by $+40\text{–}50\%$ and cardiac output increases by $+30\text{–}50\%$.

What causes physiologic anemia of pregnancy?

Plasma volume rises faster than red blood cell (RBC) mass, diluting hemoglobin and hematocrit (H&H).

Why is left-lateral positioning recommended after the first trimester?

To prevent supine hypotension syndrome caused by vena cava compression when lying flat on the back.

What respiratory adaptations cause expected mild dyspnea in pregnancy?

Elevation of the diaphragm and increased tidal volume caused by the expanding uterus.

What causes rhinitis of pregnancy (nasal stuffiness)?

Estrogen causes nasal congestion and stuffiness.

What physiological changes explain why heartburn is common in pregnancy?

Progesterone relaxes the lower esophageal sphincter (LES) while the expanding uterus displaces the stomach.

Why does urinary frequency return in the third trimester?

The fetal head descends into the pelvis (lightening), putting renewed pressure on the bladder, combined with increased GFR.

Which hormones cause joint and ligament loosening in the musculoskeletal system during pregnancy?

Relaxin and progesterone.

What primary metabolic function does human placental lactogen (hPL) serve?

hPL exerts an insulin-antagonist effect to prioritize glucose availability for the fetus.

What sentence helps summarize the key roles of progesterone, estrogen, and hCG in presumptive signs?

"Progesterone makes her tired and keeps her pregnant. Estrogen changes her skin and her vessels. hCG makes her sick."

What clinical benefits does a serum quantitative $\beta$-hCG test provide over qualitative tests?

It measures the exact hCG level, detects pregnancy as early as $\sim 6\text{–}8\,\text{days}$ post-conception, and trends viability (doubling every $48\text{–}72\,\text{hours}$ early) or helps evaluate ectopic pregnancy/miscarriage.

At what gestational age can transvaginal vs. transabdominal ultrasounds first visualize the gestational sac/fetus?

Transvaginal ultrasound visualizes the gestational sac at $\sim 4.5\text{–}5\,\text{weeks}$, while transabdominal ultrasound visualizes slightly later at $\sim 5.5\text{–}6\,\text{weeks}$.

What defines Tier 1 Presumptive signs of pregnancy and what are key examples?

Presumptive signs are subjective, patient-reported symptoms that are least reliable because other conditions can mimic them. Examples: amenorrhea, nausea/vomiting, breast tenderness, fatigue, urinary frequency, quickening, chloasma, and linea nigra.

What defines Tier 2 Probable signs of pregnancy and what are key examples?

Probable signs are objective examiner findings providing strong evidence, but not absolute proof. Examples: positive urine/serum hCG, Goodell's sign, Hegar's sign, Chadwick's sign, ballottement, Braxton Hicks contractions, and abdominal/uterine enlargement.

Why is a positive hCG pregnancy test categorized as a probable sign rather than a positive sign?

Rare conditions (such as hCG-secreting tumors or certain medications) can occasionally cause false-positive results.

What are the only 3 diagnostic findings classified as Tier 3 Positive signs of pregnancy?

1. Fetal heart tones auscultated.
2. Fetal movement palpated by the examiner.
3. Ultrasound visualization of the fetus.

What patient instructions maximize the accuracy of home urine pregnancy tests?

Test using first-morning urine for the most concentrated hCG reading, and repeat negative tests in a few days if menstruation does not start.