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A comprehensive overview of key concepts and questions related to pregnancy and childbirth, covering topics such as hormonal changes, physical adaptations, prenatal care, fetal development, and common complications. It includes definitions, explanations, and examples, making it a valuable resource for students in nursing or related healthcare fields.
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Recommended weight gain for singleton pregnancy ✔✔11.5-16kg
25 - 35lbs
hCG ✔✔Human Chorionic Gonadotropin
a hormone secreted by the trophoblast cells of placenta
stimulates estrogen and progesterone
Estrogen ✔✔uterus and breast enlargement
Progesterone ✔✔A hormone produced by the ovaries
acts with estrogen to bring about the mensural cycle
maintains endometrium and inhibits contractions
Relaxin ✔✔softening collagen in joints
softens cervix
inhibits contractions
hPL ✔✔human placental lactogen
insulin antagonist
BMR ✔✔increases 20-25% d/t fetal metabolic activity
may cause sensation of overheating
Thyroid Gland ✔✔increases by 50%
more thyroxin released
parathyroid gland ✔✔increase size and hormone concentration
increases use of calcium and vit D
blood volume increase during pregnancy ✔✔1500mLs (~45%)
heart rate increase in pregnancy ✔✔ 10 - 15bpm
Breasts during pregnancy ✔✔o Soon after conception - tingling, tenderness, swelling
o Size & nodularity increase
o Superficial veins more prominent
Nipples increase erectile
o Areola darkens
o Montogomery's Tubercules
§ Sebaceous glands of the areola become enlarged
§ Secretions from these glands prevent cracking
o Colostrum
§ Antibody Rich
§ May be expressed around 16 weeks
§ May leak in last trimester
Respiratory changes in pregnancy ✔✔· Tidal volume increases throughout pregnancy
o 30- 4 0% rise in volume of air each minute
· O2 consumption increased by 20-40%
· Rib cage flare - up to 6cm
· Elevated diaphragm
Subjective changes in pregnancy ✔✔o Amenorrhea
o "Morning Sickness"
o Excessive Fatigue
o Urinary Frequency
o Changes in breasts
Objective changes in pregnancy ✔✔o Goodell's Sign
o Chadwick's Sign
o Hegar's Sign
o Positive Pregnancy Test
o Progressive Uterine Enlargement
o Palpation of Fundus
1st trimester ✔✔week 1-
2nd trimester ✔✔14-26 weeks
add 7 days to LMP and count forward 9 months
GPTPAL ✔✔G: Gravida -Total # of pregnancies including current pregnancy
P: Para- Total # of pregnancies carried and DELIVERED to a viable age
o (>20 weeks)
T: Term - # of term births (≥ 37 wks gestation)
P: Premature - # of premature births
o (≥ 20 weeks gestation <37 weeks)
A: Abortion - # of therapeutic or spontaneous abortions
o (<20 weeks gestation)
L: # of living children
Leopold's Maneuvers ✔✔A series of four maneuvers designed to provide a systematic approach whereby the examiner may determine fetal presentation and position.
1st Maneuver - Fundal Grip
o Assess which fetal part is in the fundus by placing hands on top of the fundus.
2nd Maneuver - Umbilical Grip
o Assess which parts are on the side of the uterus by placing the hands on the side of the uterus
3rd Maneuver- Pawlick's Grip
o Grasp the lower abdomen with the thumb and fingers just above the symphysis pubis to assess what part of the fetus is presenting
4th Maneuver- Pelvic Grip
o Place both hands on the lower abdomen and assesses engagement
If the presenting part has descended deeply, only a small portion of it may be outlined
Isoimmunization ✔✔If fetal Rh-positive blood leaks into the Rh-negative mother's circulation, her body may respond by making antibodies to destroy the Rh-positive erythrocytes.
To prevent: 28weeks: ALL Rh negative woman are given 300 ug of anti-D IgG IM (WinRho)
Indirect Coombs' test (DAT) ✔✔indicates if a woman (or infant) has been sensitized (exposed) to Rh positive blood
Kleihauer-Betke Test ✔✔measures fetal hemoglobin transferred from fetus to maternal bloodstream.
Monozygotic ✔✔developed from a single fertilized ovum, as identical twins
o Polycythemic, circulatory overload to hydrops (kinda like fetal edema)
o Heart failure, hyperbilirubinemia à kernicterus
Biophysical profile ✔✔- Score out of 10
§ NST (nonstress test)
§ Breathing Movement
§ Body Movement
§ Muscle Tone
§ Amniotic Fluid Volume
Weight gain for twins ✔✔o Between 9.1-13.6 Kg by 20 weeks
o Approx. 0.68 Kg/week
Goal term for twin pregnancy ✔✔36-37 weeks
Group B strep ✔✔Need to be tested every pregnancy, as mom may be negative one time, positive the next
Increase infant mortality rate
Swab at 35-37wk
Mom needs 2 doses of antibx and even then, monitor baby after delivery
Group B step risk factors ✔✔Positive prenatal culture
Preterm birth
Premature rupture of membranes (for longer than 18 hours)
Intrapartum maternal fever > 38 degrees.
GBS positive bacturia- regardless of culture count
TDAP ✔✔Pertussis increasing infant mortality
Tx is to vaccinate/booster shot mom (even if she's upto date, recc'd EVERY pregnancy 21- 32wks) and surrounding family (partner/dad, grandma, grandpa, make sure siblings are up to date, etc.)
Mrs. Gonzalez is 28 weeks pregnant. She has a 2 year old born at 36+6, 4 year old born at 37+0, 7 year old born at 41+2 and 10 year old born at 38+1. She had an 11 week loss, 17 week loss and 21 week loss ✔✔GPTPAL:
8, 5, 3, 2, 2, 4
hyperemesis gravidarum ✔✔severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus
5% weight loss
hyperemesis gravidarum risk factors ✔✔o Young maternal age
o Nulliparous
o Low SES
o Unplanned Pregnancy
o High BMI
o Smoking
o HG in previous pregnancy
hyperemesis gravidarum treatments ✔✔IV fluids
I&O monitoring
· Dipping urine for protein & ketones
Pharmacological interventions
· Diclectine (PO and vaginal supp)
TPN
Fetal monitoring - consider gestation
placenta previa ✔✔4 types:
low lying - Does not cover internal cervical os
marginal - Includes lower edge of the placenta extending but not covering the internal os (not pictured)
partial - partially covers dilated internal cervical os
complete - covers internal cervical os
Risk factors for placenta previa ✔✔Previous C/S
Previous Previa
Previous Termination
Multiparity
Maternal age > 35 years
gestational diabetes ✔✔o No pre-existing diabetes
o Develops carbohydrate intolerance in pregnancy
o Approximately 4% of pregnant women
o May be controlled with diet or medication depending on severity
Less microvascular complication to mom dt being short lived, more complications for fetal development
gestational diabetes risks for fetus ✔✔Macrosomia
Congenital Anomalies
SA (spontaneous abortion)
Gestational diabetes test ✔✔1hr Glucose Challenge Test (50 g) @ 24-28 Weeks
Ø 10.3 mmol/L = GDM
Ø 7.8-10.2 mmol/L = 75 g GTT
Ø <7.8 mmol/L = normal
Maternal Hyperglycemia ✔✔Macrosomia
Congenital Anomalies
IUFD (intrauterine fetal demise)
Gestational Diabetes Goals ✔✔Goal: Maintain BGM between 4-7 mmol/L
D5W infusion when 3cm+ dilated in labour, automatically
BGM >7.0mmol/L in labor =Insulin drip started w. D5W
Postpartum - monitor BGM
o Tend to return to pre-pregnancy levels.
Future Considerations.....
o DM type 2 risk for mom and baby
Hypertensive Conditions in Pregnancy ✔✔2 Categories:
Preeclampsia: hypertension after 20 weeks w. proteinuria
Eclampsia: Medical emergency (siezures)
Pregnancy hypertension risk factors ✔✔Primipara
New partner
Hypertonic Reflexes (hyperreflexia, CNS is very easily excited)
CLinical management of gestational htn ✔✔BP
Reflexes Fluid Balance Urine Blood Work Pharmacological Anti-hypertensive Anti-seizure Rest DELIVERY***
HELLP syndrome ✔✔Hemolysis,
Elevated Liver Enzymes,
Low Platelet Count
Tx for cervical insufficiency ✔✔Cerclage - stitch to prevent cervix from opening on own
Ruptures of membranes ✔✔PROM- premature rupture of membranes
SROM- spontaneous rupture of membranes
PPROM- preterm premature rupture of membranes
AROM/ARM- artificial rupture of membranes
When to go to hospital?
when contractions are... ✔✔Regular
Gradually become closer together
o Q4-6 min & lasting 30-60 seconds for about an hour
4 Ps of Labour ✔✔Passage
Passenger
Powers
Phases
The passage ✔✔4 Classical Types:
Gynecoid**
