OB Lecture Exam 3

ch. 5 (violence against women), ch. 13 (a&p of pregnancy), ch. 14 (nursing care of the family during pregnancy), ch. 15 (maternal nutrition)

ch. 13 (uterus during pregnancy) - alters size, shape, and position; Hegar sign indicates softening of the lower uterine segment by 6 weeks

uterine growth

ch. 13 (uterus during pregnancy) - increased blood flow and contractility lead to Braxton Hicks contractions; fetal-related changes include ballottement and maternal perception of __________

quickening (first movements perceived by the pregnant woman)

ch. 13 (cervix during pregnancy) - the cervix remains firm and closed; __________ develops from increased vascularization; mucus plug (operculum) forms

Goodell sign (softening of the cervix during early pregnancy)

ch. 13 - ovarian ovulation ceases; __________ produces hormones that support amenorrhea in early pregnancy (ovaries during pregnancy)

corpus luteum

ch. 13 (vagina during pregnancy) - __________ appears; hormonal changes increase leukorrhea and lower vaginal pH

Chadwick sign (blue discoloration of vaginal and pelvic mucosa)

ch. 13 - __________ pelvic blood flow and uterine pressure cause vulvar edema and varicosities (vulva during pregnancy)

increased

ch. 13 - __________ from plasma volume increase leads to physiologic anemia; Hgb <11 g/dL (1st/3rd trimester) or <10.5 g/dL (2nd trimester) is diagnostic (blood during pregnancy)

hemodilution

ch. 14 - is calculated from the first day of the last menstrual period using Nägele’s Rule—subtract 3 months, add 7 days, and adjust the year; can also be confirmed by early ultrasound, with pregnancy lasting ~280 days or 40 weeks

estimated date of birth (EDB)

ch. 14 - was is the EDB when the patient says the first day of her last menstrual period was december 21, 2024?

september 28, 2025

ch. 14 - __________ is the number of times a woman has been pregnant, regardless of outcome; __________ counts pregnancies reaching 20 weeks, not the number of fetuses

gravity (G); parity (P)

ch. 14 - what is the gravida & parity of a woman who had 3 pregnancies and normal deliveries, but the third was a twin birth?

G3; P3

ch. 14 - what does GTPAL stand for?

G - gravida

T - term

P - preterm

A - abortion

L - living

ch. 14 - J. D. is 8 weeks pregnant and is at her first prenatal visit. she has two children aged 9 delivered at 38 weeks and 4 delivered at 36 weeks. what is the GTPAL?

G - 3

T - 1

P - 1

A - 0

L - 2

ch. 14 - who provides prenatal care (PNC)?

obstetricians, certified nurse midwives, and family physicians

ch. 14 - where is PNC provided?

clinics, hospitals, and private practices

ch. 14 - what is the goal of PNC?

to promote a healthy pregnancy, monitor fetal/maternal well-being, and prevent complications

ch. 14 - how early should PNC begin?

as early as possible—ideally in the first trimester (by 12 weeks)

ch. 14 - what are barriers to attending PNC?

lack of insurance, transportation, and childcare

ch. 14 - what care is offered during PNC visits?

physical exams, labs, and screenings

ch. 14 - 1st (weeks 1-13), 2nd (14-26), 3rd (27-40)

pregnancy has 3 trimesters

ch. 14 - every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then weekly until birth

prenatal visits

ch. 14 - includes interview, full health and OB history, physical exam, lab tests, and education on pregnancy care, nutrition, hygiene, and breastfeeding prep

initial PNC visit

ch. 14 - include interview, vital signs, weight, urinalysis, physical exam, fundal height, fetal assessment, and ongoing teaching

PNC follow-up visits

ch. 14 - position supine with right hip wedge, inspect, palpate, and measure fundal height from pubic bone to fundus (from 2nd trimester)

abdominal assessment

ch. 14 - check gestational age, fetal heart tones (~12 weeks via Doppler), movements, quickening (16–20 weeks), and confirm with ultrasound if needed

fetal assessment

ch. 14 - poses increased risk in pregnancy; assess privately using direct questions, build trust, and follow ABCDES (alone, belief, confidentiality, documentation, education, safety) interventions

intimate partner violence (IPV)

ch. 14 - by 13 weeks, the uterus rises into the abdomen; at __________, it’s midway between pubis and umbilicus

16 weeks

ch. 14 - at __________, the fundus reaches the umbilicus

20-22 weeks

ch. 14 - between 28–32 weeks, fundal height matches gestational age ±2 weeks; by __________, it’s midway to xiphoid

26-28 weeks

ch. 14 - at 36 weeks, it reaches the xiphoid; at __________, fundal height may drop due to lightening

38-40 weeks

ch. 14 - include CBC, blood type and Rh with antibody screen, urinalysis with culture, rubella titer, STI panel (syphilis, HIV, hep B), gonorrhea and chlamydia testing, and optional ultrasound/genetic screening

labs at PNC initial visit

ch. 14 - repeat CBC, syphilis, HIV, and hep B labs; screen for gestational diabetes, chromosomal abnormalities, and NTDs

28 week visit labs

ch. 14 - test for group B streptococcus and administer recommended immunizations including Rhogam (if Rh negative), Tdap, hep B, and influenza

35-37 week visit labs & immunizations

ch. 14 - key topics such as nutrition, prenatal vitamins, personal hygiene, infection prevention, safe physical activity, and preparation for breastfeeding

self-management during pregnancy

ch. 14 - high-mercury fish (shark, swordfish, king mackerel), raw/smoked seafood, unpasteurized dairy (soft cheeses), uncooked eggs/sprouts, unheated deli meats/hotdogs, and all alcohol

foods to avoid during pregnancy

table 14.3 - what are five most common discomforts in the first trimester of pregnancy?

N/V (morning sickness), fatigue, breast tenderness, urinary frequency, and mood swings/emotional lability

table 14.3 - what are five common discomforts in the second trimester of pregnancy?

heartburn, constipation, backache, round ligament pain, and supine hypotension

table 14.3 - what are five common discomforts in the third trimester of pregnancy?

SOB, urinary frequency, Braxton Hicks contractions, leg cramps, and ankle edema

table 14.4 - what are five signs of potential complications in the first trimester of pregnancy?

severe vomiting, fever/chills, burning with urination, abdominal cramping, and vaginal bleeding

table 14.4 - what are five signs of potential complications in the second and third trimesters of pregnancy?

sudden fluid discharge from the vagina before 37 weeks, decreased fetal movement, severe backache, visual disturbances, and swelling of the face and fingers

ch. 15 - __________ should be taken before conception to help prevent NTDs; found in leafy greens, legumes, citrus fruits, and fortified grains

folate (400 mcg daily)

ch. 15 - what are the nutrient and weight gain needs during pregnancy?

prepregnancy BMI guides healthy weight gain. gaining too little or too much can increase risks for mother and baby.

ch. 15 - 2–4 lbs in the 1st trimester, then ~1 lb/week for normal weight; 0.6 lb/week if overweight; 0.5 lb/week if obese

weight gain patterns during pregnancy

table 15.2 - what tissues contribute to maternal weight gain at 40 weeks gestation?

fetus, placenta, amniotic fluid, increased blood volume, and maternal fat stores

ch. 15 - pregnant women need protein for __________, fats and carbs for __________, plus vitamins (A, D, E, K, folate, B6, B12, C) and minerals (iron, calcium, magnesium, zinc, choline) to support fetal development and maternal health.

growth; energy

table 15.3 - calcium needs during pregnancy and lactation are 1000–1300 mg daily. what are non-dairy sources of calcium?

sardines (with bones), calcium-set tofu, and dark leafy greens (except spinach or Swiss chard)

ch. 15 - vegetarian diets vary in form, with all emphasizing plant-based foods; lacto-vegetarians include dairy, lacto-ovo-vegetarians include eggs and dairy, while vegans consume only plant products and may risk deficiencies __________, __________, and __________ during pregnancy.

iron; vitamin B12; calcium

ch. 15 - gluten-free diets, often chosen for perceived health benefits, are only medically necessary for those with celiac disease or gluten sensitivity and may lead to deficiencies in __________, __________, and __________ if not balanced with gluten-free whole grains.

folate; thiamine; iron

CDC article in ch. 15 pptx - __________, a harmful germ found in some foods, can cause pregnancy loss or serious newborn illness even if the mother shows mild symptoms; pregnant women should avoid high-risk items like unheated deli meats, raw sprouts, and unpasteurized dairy, and instead choose safer options like reheated meats, pasteurized cheeses, and cooked sprouts to protect their baby

listeria

quiz 2 prep - as the clinic nurse, what instructions would you give to a group of pregnant women in preventing constipation? select all that apply.

a) perform regular exercises such as walking

b) take stool softeners as needed

c) increase green leafy veggies

d) consume 8-10 glasses of water daily

e) have 20 mL olive oil once a week

a. perform regular exercises such as walking

c. increase green leafy veggies

d. consume 8-10 glasses of water daily

rationale: pregnant women should prevent constipation by exercising regularly, eating high-fiber foods like leafy greens, and drinking plenty of water. stool softeners are not routinely recommended without a provider’s order. olive oil is not a standard or evidence-based remedy for constipation in pregnancy.

quiz 2 prep - a pregnant client visits the clinic for her first prenatal visit. H\her obstetric history includes 2 live births at term, 1 stillborn at term, and 1 miscarriage at 6 weeks. what is her GTPAL?

a) G4T3P1A1L2

b) G5T3P0A1L2

c) G5T3P1A1L3

d) G4T3P0A1L2

b) G5T3P0A1L2

rationale:

G (gravida) = 5 → 2 live + 1 stillborn + 1 miscarriage + 1 current

T (term) = 3 → all 3 babies were full-term

P (preterm) = 0 → no babies born between 20–36 weeks

A (abortion) = 1 → 1 miscarriage before 20 weeks

L (living) = 2 → only the 2 live births are living

quiz 2 prep - hormone produced by the ovary that relaxes smooth muscles during pregnancy

progesterone