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Group B strep can cause UTI, pyelonephritis, chorioamnionitis, PTL, vaginal discharge, PP endometritis, post c-section wound infection, and rarely endocarditis. It is not known to cause oligohydramnios

Herpes treatement

C-section

Risk factor for ectopic pregnancy

History of: STI, ectopic pregnancy, surgery, endometriosis, hormone use, IUD, IVF

Probable signs of pregnancy

\-Hegar sign

\-Goodell’s sign

\-Chadwick’s sign

\-Braxton-hicks contractions

\-Positive pregnancy test

\-Ballottement

Stomach and intestinal changes of pregnancy

\-Morning sickness

\-Most notable during first trimester

\-Never dismiss n/v-

\-Constipation & flatulence

Pituitary hormones

FSH, LH, prolactin, oxytocin

Pituitary Hormonal influences during pregnancy

\-Influence ovarian follicular development

-Prompt ovulation

\-Alter metabolism

\-Stimulate lactation

\-Pigmentation changes

\-Uterine contractions

\-Milk ejection from breasts

\-Vasoconstriction

Ovarian hormones

estrogen/progesterone

Function of ovarian hormones

\-Maintain endometrium

\-Aid in implantation

\-Decrease uterine contractility

\-Initiate breast ductal system development

Placental hormones

hCG, hPL, estrogen, progesterone

Function of placental hormones

\-Protect pregnancy from immune response

\-Make glucose, protein, and minerals available for fetus

\-Growth of uterus & breast tissue

\-Relax smooth muscle

\-Loosening of pelvis & other major joints

Uterine changes during pregnancy

\-Uterine growth

\-Wall thins out

-Blood flow increased

\-Braxton-Hicks contractions

\-Round ligament pain

Cervical changes during pregnancy

\-+Chadwick’s sign

\-Goodell sign 

\-Forms mucus plug  

\-Leukorrhea

Vaginal and vulva changes during pregnancy

\-Bluish purple hue

\-Edema

\-Thickening of vaginal mucosa

\-Rugae

\-pH: decreases from 6.0 to 3.5

\-More susceptible to yeast infections 

\-Dyspareunia

Ovarian changes during pregnancy

Ovulation ceases

Breast changes during pregnancy

\-Fullness, tingling, increased sensitivity

\-Superficial veins become prominent 

\-Enlargement of nipples, areola, Montgomery’s tubercles

\-Increased pigmentation

\-Begin early milk production

Cholasma

mask of pregnancy. Hyperpigmentation of the skin

Linea nigra

Hyperpigmented line across the belly

Striae Gravidium

Stretch marks

Angiomas

benign growths made up of small blood vessels

Palmar erythema

redness of the palms

Changes in the hair and nails during pregnancy

thicker

Pruritus

itching

Cardiovascular changes of pregnancy

\-Cardiac hypertrophy

\--Increased blood volume

\--Increased cardiac output 

\-Heart sound changes

\-Changes in blood pressure 

\--Supine hypertensive syndrome

\-Stasis of blood in lower extremities

\--Varicose veins

\--Dependent edema

\-Supine Hypotension 

\-Orthostatic hypotension 

\-Physiologic anemia

\--Dilution

\---RBCs

\---Albumin

\--Need for iron- especially last 4 weeks

\-Increased need for iron for hgb formation

\-Dilution of plasma albumin 

\-Increased WBC count 

\-Increased fibrinogen volume & other clotting factors

\-Immunoglobulins sent to fetus

Neurological changes of pregnancy

\-Decreased attention span

\-Poor concentration

\-Memory lapses

\-Carpal tunnel syndrome

\-Syncope

\-Fatigue

\-Insomnia

Respiratory changes of pregnancy

\-Increased tidal volume

\-Increased oxygen consumption

\-Elevated diaphragm

\-Increased chest circumference

\-Hyperventilation

Eye changes during pregnancy

Blurred vision 

Nasal changes during pregnancy

Nasal stuffiness, congestion

Mouth changes during pregnancy

\-Inflammation of gums, bleed easily

\-Ptyalism-excessive salivation,

\-Change in taste and smell

Esophageal changes during pregnancy

\-Pyrosis (heartburn)

Bladder changes during pregnancy

\-Urinary frequency and urgency

\-Nocturia

\-Increased risk for UTI 

Kidney and ureter changes during pregnancy

\-Ureters elongate and dilate

\-Reduced peristalsis along the ureter

\-Pressure from uterus

\-Glomerular filtration rate & blood flow to kidneys increased 

\-Increased glucose in urine

Thyroid gland changes during pregnancy

Levels increased (free T4)

Parathyroid gland changes during pregnancy

Parathyroid hormone increases-

Adrenal gland changes during pregnancy

\-Increased cortisol- 

\-Increased aldosterone- 

Pancreas changes during pregnancy

Increased number, size of beta cells- 

Postural changes of pregnancy

\-Lumbar lordosis-

\--Backache

\-Waddle gait

Calcium storage during pregnancy

\-Decreased maternal serum calcium

\-Lower extremity cramps

Goal of preconception healthcare

\-Optimize health & wellness prior to conception

\-Manage risks & risky behaviors

Inclusions of preconception healthcare

\-Reproductive history

\-Prior & present health status

\-Diseases/complications

\-Family medical

\-Sociodemographic

\-Self care

\-Lifestyle

\-Mental health

\-Beliefs/practices

\-Environmental

\-Financial

Prenatal care

Careful assessment of fetal well being enhances perinatal outcome through early identification and intervention for fetal compromise

Goal of prenatal care

\-recognize deviations from normal

\-provide individualized evidence based care

\-Prevent fetal injury or death

\-Help ensure best possible fetal outcome

\-Identify fetuses that are healthy (thus preventing unnecessary intervention)

Prenatal care schedule

\-Every 4 weeks until 28-32 weeks

\-Every 2 weeks until 36 weeks

\-Weekly until birth

Presumptive signs of pregnancy

\-Amenorrhea

\-Nausea/vomiting

\-Urinary frequency

\-Breast tenderness

Positive signs of pregnancy

\-Fetal heartbeat

\-Fetal movements

\-Visualization of fetus

Calculating EDB

Date of last normal menstrual period- 3 months + 7 days

Category A prescriptions

Safe for pregnancy

Category X prescriptions

Extremely unsafe for pregnancy

Preterm

< 38 weeks

Term

38 weeks 0 days, to 31 weeks 6 days

Post term

> 42 weeks 0 days

Nulligravida

A woman who has never been pregnant

First prenatal appt.

\-Comprehensive health history

\-Biographical information

\-Social history

\-Psychological assessment

\-Obstetric history

\-Current pregnancy

\-Physical assessment

Uterine position at 12 weeks

level with symphysis pubis

Uterine position at 20 weeks

level with umbilicus

Measuring fundal height after 20 weeks

\-Most often measured with tape measure starting around 22 weeks

\-Equals # of weeks from 22-34

Prenatal physical exam

\-Prepare patient and environment

\-General assessment

\-Nutritional assessment 

\-Vital signs- BP especially

\-Urine specimen

\-Head, neck, lungs

\-Skin

\-Breasts

\-Abdomen

\-Vagina/pelvis

\--External

\--Internal

\--Bimanual exam

\--Evaluation of pelvis- pelvimetry

First Leopold maneuver

determine fetal body part that occupies uterine fundus

Second Leopold maneuver

determine location of fetal back

Third Leopold maneuver

confirm presentation; determine engagement

Fourth Leopold maneuver

determine fetal attitude, extension

Fetal heart auscultation

\-In cephalic (vertex presentation) best heard over fetal back (maternal RLQ or LLQ)

\-In breech may be best heard in RUQ or LUQ

\-110 to 160 beats/minute

\--Fetoscope, Pinard stethoscope- 

\--Doppler ultrasound stethoscope-

Nutrition and weight gain

\-Calories- 300 cal increase

\-Protein- need for tissue growth & repair

\-Water- 8-10 glasses (8oz) per day)(normal 6-8)

\-Vitamins/minerals- Ca, Vit D, Iron, Vit C, Folic Acid

Childbirth class topics

\-A&P related to pregnancy

\-Comfort measures

\-Labor  & birth process

\-Relaxation

\-Complications

\-Postpartum care

\-Newborn care

Pregnancy screenings

\-Blood typing

\-Rh factor

\-Antibody screen

\-CBC- WBC, Hgb, Hct

\-Group B strep

\-UA

\-Glucose tolerance test

\-Pap smear- cervical cancer

\-Sexually transmitted infections- HIV, Gonorrhea, Chlamydia, Syphilis (required by law)

\-Hep B

Testing during pregnancy

\-Chorionic villus sampling

\-Percutaneous umbilical cord sampling

\-Amniocentesis

\--all done under ultra sound

Antepartum diagnostics

\-Ultrasonography

\-Kick counts

\-doppler ultrasound bloodflower

\-Biophysical profile

\-NST

\-Acoustic stimulation

\-Contraction stress test

Preterm labor

\-Cervical changes and regular contractions occurring between 20-37 weeks.

\-Morbidity/Mortality- survival rate increases as gestational age increases

\-Risk Factors-

\--History of abruption, uterine over distension, cervical incompetence, bacterial infections, multiple gestations, HTN, DM, low pregnancy weight, late or no prenatal care, smoking ,drugs, alcohol, trauma, stress, etc.

Cervical insufficiency

Inability of the cervix to retain a pregnancy to term

Cervical insufficiency management

\-TVU and cervical length monitoring

\-Cerclage

\-Bedrest

\-Home uterine monitoring

\-Betamethasone

Maternal risks for multiple gestation

\-Hypertensive disorders

\-Gestational diabetes

\-Hemorrhage after delivery

\-Anemia

\-Heart conditions

\-Cholestasis

\-Acute fatty liver

\-Cesarean birth

Fetal risks for multiple gestation

\-Increase in morbidity/mortality

\-Delivery before term

\-Increase of low birth weight

\-Increase of IUGR

\-Twin-to-twin transfusion syndrome

Hyperemesis gravidarum

Extreme N/V, unrelated to other causes, with symptoms of starvation (ketonuria), some weight loss, electrolyte & fluid imbalances

Risk factors for hyperemesis gravidarum

\-Increased placental mass- multiple gestation & molar pregnancy

\-History of HG, motion sickness or migraines

\-Family hx of disease

\-Women carrying a female child

Risk factors for gestational diabetes

-> than 25 yrs

\-Obesity

\-Insulin resistance

\-PCOS

\-Hx of GDM

\-Hx of LGA infant

\-Stillbirth, miscarriage or infant with congenital anomalies in previous pregnancy

\-Family Hx of Type 2 DM

\-Ethnicity

Morbidity and mortality of gestational diabetes

\-3x more likely to develop preeclampsia or eclampsia

\-2x likely for Spontaneous abortion

\-5x more likely perinatal death

\-2-3x more likely for congenital malformations

\-LGA

\-Increased rate of infection, hydramnios, postpartum hemorrhage, c/section

Screening and diagnostics

\-24-28 weeks gestation

\-Glucose Challenge test

\-3 hour OGCT

\-GDM made when two or more values are above norm

\--Fasting < 90

\--1 hour

Management of gestational diabetes

\-Home blood glucose monitoring

\-Ongoing fetal surveillance 

\-Diet/Exercise

\-Possible insulin or oral hypoglycemic

Chronic htn

Hypertension that is present and observable before pregnancy or diagnosed before 20th week gestation, persists beyond 84 days postpartum (>140mm/90mmHg)

gestational htn

Blood pressure elevation after mid-pregnancy

transient htn

used only when pregnant, women who develop gestational HTN, but it resolves within 12 weeks PP

preeclampsia

Hypertension with proteinuria, progresses from mild to severe

Cause of preeclampsia

\-vasospasm and endothelial cell damage, exaggerated response to angiotensin II

\-Reduces blood flow to organs including the placenta

\-Activates the coagulation cascade

\-Affects liver, kidneys and CNS

\--Proteinuria

\--Edema

\--CNS effects

\--Hyperreflexivity

Risk factors for preeclampsia

History of preeclampsia, age extremes, multiple gestation, pregestational DM, previous pregnancy with preeclampsia, obesity,  African America, vitamin deficiencies

Management for preeclampsia

\-rest

\-Educating about danger signs: visual changes, epigastric pain, N/V, bleeding gums, headaches, increasing edema especially of hands and face, decreased UO, decreased fetal movement

\-Severe management

\--Magnesium sulfate

\--Antihypertensives

\--Hemodynamic monitoring

Eclampsia

Occurrence of grand mal seizures in women who either have gestational hypertension or preeclampsia

complications of eclampsia

\-Cerebral hemorrhage

\-Aspiration pneumonia

\-Hypoxic encephalopathy

\-Coma

\-Thrombosis

\-Death

HELP syndrome

\-H- Hemolysis  

\-EL- Elevated Liver Enzymes

\-LP- Low Platelet levels

Signs and symptoms of HELP syndrome

\-Decreased liver function

\-Thrombocytopenia

\-Epigastric pain

\-Malaise

\-Influenza like complaints

\-n/v

\-Headache

\-Shoulder pain

\-Bruising

\-Hematuria

DIC

\-Pathological form of clotting that is diffuse and consumes large amounts of clotting factors

\-Causes widespread external or internal bleeding

Cause of DIC

\-most common- excessive blood loss with inadequate replacement, placental abruption, amniotic fluid embolism, severe preeclampsia/HELLP syndrome

Nursing care for DIC

\-Meticulous assessment for bleeding

\-Catheter for U/O monitoring

\-Vital signs/fetal assessments

\-Side-lying

\-O2 administration

\-Administration of blood products

Placenta previa

\-Implantation of placenta in lower uterine segment, near or over the cervix

\-Complete (total), partial, or marginal

Risk factors for placenta previa

\-History of c/section, previous abortions, diabetes, smoking, cocaine use, placenta previa, close spaced pregnancies;  African or Asian, or >40 yrs. old

Placental abruption

Premature separation of placenta after 20 weeks gestation, Causes hemorrhage between uterine wall and placenta

Risk factors for placental abruption

\-History of hypertension, smoking, multiparity, abortions, illicit drug use, uterine fibroids

\-Short fetal umbilical cord, abdominal trauma, rupture of membranes

Variations of placental abruption

\-partial concealed

\-partial apparent

\-complete concealed 

Spontaneous abortion

Pregnancy that ends prior to 20 weeks gestation

Complete abortion

All products of conception are expelled and cervix closes

Incomplete abortion

Some of the products of abortion are expelled