The Prenatal Journey

primary- prevention

secondary- screening

tertiary- treatment

minimal intervention and hormonal only methods have NO protection against STIs

Gravida is the # of PREGNANCIES (regardless of length, deliveries, or abortions)

Para is the # of BIRTHS

So twins would still be 1 para*

anything before 37 weeks is PRE-TERM since 37-38 6/7 is early term

Nulligravida would be a G 0

Primigravida would be a G 1

the 1 hr GTT test is screening, the 3 hr GTT test is diagnostic

the Depo injection tends to cause

delay in fertility return after use

what combination meds are given before 9 weeks (usually) to terminate pregnancy medically?

Mifeprex/Methotrexate

What does the acronym PRESUME stand for?

P- period absent (amenorrhea)

R- really tired (fatigue)

E- enlarged breast

S- sore breast

U- urination increased

M- movement of fetus in uterus (quickening or fluttery sensation in lower abdomen; 20th week in first-time moms, maybe a little earlier in 2nd time moms)

E- emesis & nausea

almost all signs are similar to period symptoms

is movement of fetus in uterus felt by mom (quickening or fluttery sensation in lower abdomen; 20th week in first-time moms, maybe a little earlier in 2nd time moms) probable or presumptive

presumptive

What does the acronym PROBABLE stand for?

P- positive pregnancy test

R- returning of fetus against fingers when uterus is pushed during palpation) “eternal ballottement”

O- outline of fetus can be palpated

B- Braxton Hicks contractions (false labor)

A- a softening of the cervix (“Goodell’s sign”)

B- bluish color to the vulva, cervix, vagina (“Chadwick’s sign”)

L- lower uterine segment becomes soft (“Hegar’s sign”)

E- enlarged uterus

what type of pregnancy sign is braxton hicks? probable or positive

enlarged uterus?

mom feeling fetus move in uterus (quickening)

doctor feels outline of fetus

doctor feels movement of fetus

doctor sees movement of the fetus

probable

probable

presumptive

doc feel outline of fetus is probable (tumor) . doc feel and see movement is positive

Fetal heart begins to beat and circulate blood by end of ________ week

3rd

Heartbeat visible on ultrasound by week

6

the placenta is composed of amniotic membranes, amniotic fluids, and an umbilical cord.

there are 2 separate membranes.

the _________ is the inner membrane

the _________ is the outer membrane

inner Amnion; outer Chorion. these 2 membranes form the amniotic sac

before 20 weeks, the amniotic fluid is mostly

water

what are the primary contributors to the amniotic fluid (in late gestation)?

fetal urine and lung secretions

Organogenesis is complete by week

9

Fetal Heartbeat can be heard by Doppler by week _____

10

Face with recognizable features develops by week _____

10

by week 12, the fetal length is estimated to be ______ inches, and weight ______ ounces

5-6 inches;

2 oz

Fetal respiratory movements and surfactant production develops by week? full lung maturity not done until week ?

24, 36 (end of 2nd then right before term)

by week 28, the fetal length is estimated to be ______ inches, and weight ______ lbs/ounces

14-15 inches;

2 lbs, 12 oz

eyes are open by week

28

Rapid brain development occurs during the third trimester and is complete by week _____

32

fetal full lung maturity develops by week _____

36

the fetus has complete subcutaneous fat deposition by week _____

38

by week 40, the fetal length is estimated to be ______ inches, and weight ______ lbs

19-21 inches;

7-8 lbs

NEUROLOGICAL PREGNANCY CHANGES

•Decreased attention span/ concentration/ memory

•Headaches/Carpal tunnel syndrome/ sciatica

•Syncope

Greatest risk of anemia during pregnancy occurs at ________ weeks

32-34

*pregnancy increases need for iron

a baby born 37 weeks through 38 weeks & 6 days would be

early term

a baby born 39 weeks through 40 weeks & 6 days would be

full term

a baby born 41 weeks through 41 weeks & 6 days would be

late term

a baby born 42 weeks and beyond would be

postterm

GRAVIDA includes...

⚬Deliveries (term & preterm)

⚬Spontaneous abortions (miscarriages)

⚬Elective abortions

⚬Medical terminations

the Initial OB visit happens at weeks _________

4-8

between weeks 8-12, and 13-27, (so really weeks 8-27) the pregnant client should be seen every ___ weeks

4

once the third trimester begins at 28 weeks, the pregnant client should be seen every _____ weeks until week 36

two

at week 36 to birth, the pregnant patient should be seen every single week*

the pregnant patient needs ______ mg/day of iron

27

what is the recommended total pregnancy weight gain for an initially underweight (<18.5 bmi) client during pre-pregnancy?

28-40 lbs

what is the recommended total pregnancy weight gain for an initially normal weight (18.5-24.9 bmi) client during pre-pregnancy?

25-35 Lb

what is the recommended total pregnancy weight gain for an initially overweight (25-29.9 bmi) client during pre-pregnancy?

12-25 lb

what is the recommended total pregnancy weight gain for an initially obese (>30 bmi) client during pre-pregnancy?

11-20 lb

CVS (chorionic villus sampling) is a diagnostic test. True or false?

When is this test done?

True;

1st Trimester

Fetal Kick Counts

GTT

GBS

H&H

Blood Type/Rh: antibody

Syphilis test (RPR)

these are all screening tests done during the _____ trimester

3rd

NST (non-stress test) and BPP (biophysical profile) are done when? Are they diagnostic or screening?

3rd trimester;

diagnostic

when are Doppler Studies done?

Are they screening or diagnostic?

3rd trimester;

diagnostic

Free fetal cell DNA maternal serologic testing can be done as early as _____ weeks

10

________ fragments of both the pregnant person and the fetus circulate in the blood and can identify trisomy 13, 18, 21

cfDNA

(circulating free DNA)

who is chromosomal testing recommended for?

(what patients are high-risk?)

-mothers over 35 yrs old

-those w/ history of chromosomal abnormalities

-those who have had suggestive results from ultrasound or positive results from other serum tests

a circulating free DNA maternal serologic test is commonly performed if a __________ screen comes back abnormal in the 2nd trimester

Quad

Chorionic Villus Sampling is done when?

1st Trimester at 10-13 weeks

Is Chorionic Villus Sampling routine?

NO

Very invasive! Only done if absolutely necessary

Is Nuchal Translucency (NT) by ultrasound routine?

when is it done?

YES

at 11-14 weeks (first tri)

PAPP-A/BHcg testing increases the accuracy of NT testing*

Valid results from the MSQS AFP test are available from ________-_______ weeks

15-22

what does an amniocentesis test for?

⚬Trisomy 21, 18, & 13

⚬Open neural tube defects

also hemolytic disease?

when is diabetes screening (OGTT) done?

3rd Trimester

a blood glucose of < _________ mg/dL after the 1 hr GTT test = NO GDM (so no 3 hr one)

130-140

if blood glucose is greater than _________ mg/dL after the 1 hr GTT test, then gotta do the 3 hr one

130-140

Begin additional surveillance _____ weeks until delivery depending on maternal history and the current condition

32

criteria for a reactive stress test:

2 or more FHR accelerations of 15 BPM (beats per minute) lasting 15 seconds, that occur within a 20 min. time frame (2-15-15-20)

A measure of the velocity of blood flow in the umbilical artery

Doppler Studies •these studies can indicate...:

⚬Potential for progressive utero-placental insufficiency

⚬Intrauterine growth restriction (IUGR)

Decreased, absent, and reverse flow of blood in the umbilical artery indicates worsening

placental insufficiency

Bowen's Family Systems Theory*

a theory of human behavior that views the family as an emotional unit and uses systems thinking to describe the unit's complex interactions

•Disease Prevention

•Healthy Habits

•Vaccines

these are all ______ prevention

primary

(health promotion)

•Pap Smear

•Mammogram

•Pelvic Exam

these are all ______ prevention

secondary

•Inpatient or Outpatient/Treatment

•Doula Postpartum Home Care

these are ________ prevention

tertiary

(health restoration)

Abstinence, Fertility Awareness (FAM), and Lactational Amenorrhea Method (LAM) are _________ intervention

minimal

how effective is fertility awareness?

71-75%

(LAM is 98%)

WHICH OF THE FOLLOWING IS A POSITIVE SIGN OF PREGNANCY?

A) FETAL MOVEMENT FELT BY THE PREGNANT PERSON

B) SOFTENING OF THE CERVIX (GOODELL'S SIGN)

C) FATIGUE

D) ULTRASOUND DETECTION OF FETUS

D) ULTRASOUND DETECTION OF FETUS

CALCULATE ESTIMATED DATE OF DELIVERY (EDD) USING FIRST DAY OF LAST MENSTRUAL PERIOD (LMP) OF DECEMBER 31ST, 2023.

OCTOBER 7, 2024

THE HORMONE RESPONSIBLE FOR A POSITIVE PREGNANCY TEST IS:

A) ESTROGEN

B) PROGESTERONE

C) HUMAN CHORIONIC GONADOTROPIN

D) FOLLICLE STIMULATING HORMONE

C) HUMAN CHORIONIC GONADOTROPIN

LARC

Long-Acting Reversible Contraceptive

when uterus suppresses the vena cava and decreases blood pressure/blood flow to extremities. do not want clients laying flat on their back

Supine hypotension

a woman who has been pregnant 4 times but had 4 miscarriages would be

G4 P0

effectiveness of the barrier method:

80-85%

Combination hormonal birth control effectiveness:

95%

who should not use combination hormonal birth control effectiveness due to estrogen side effects?

smokers

the Mini pill (POP) daily, Depo injection (3 mos), and Nexplanon Implant (3 yrs) are

Progestin-only hormonal methods

Advantages to Progestin-only hormonal methods:

No estrogen side effects

Fewer contraindications

Longer coverage (injection/implant)

the Nexplanon implant requires

placement/removal procedures

IUDS effectiveness:

98-99%

Progestin IUDs (Mirena, Skyla, Liletta, Kyleena) last _____ yrs

3-5

Non-Progestin IUDs (Paragard) last ______ yrs

10

PERMANENT birth control effectiveness:

(tubal ligation and vasectomy)

96-99%

Performed to deliberately end a pregnancy before the fetus reaches a viable age

CLINICAL TERMINATION OF PREGNANCY

Vacuum aspiration is usually done before ____ weeks

12

Average time of conception is ____ months

6

Considered infertility with active cycle monitoring for more than __________

1 year

IUI

intrauterine insemination

IVF

in vitro fertilization

things the patient FEELS are ________ signs of pregnancy

presumptive

things the provider OBSERVES are ________ signs of pregnancy

probable

a softening of the cervix

"Goodell's sign"

bluish color to the vulva, cervix, vagina

"Chadwick's sign"

lower uterine segment becomes soft

"Hegar's sign"

a positive pregnancy test is a positive sign of pregnancy. true or false?

FALSE;

this is a probable sign