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1

What are presumptive signs of pregnancy?

Reasons to think you are pregnant

2

What are some examples of presumptive signs of pregnancy?

- Breast changes- 3-4 weeks; d/t engorgement of ducts ;Can be noticed prior to missed menstrual period
- Missed menstrual period- 4 wks ;Usually the first sign
- Nausea&Vomiting-4-14 wks; d/t hCG levels; Up to 75% have this the 1st trimester
- Urinary frequency-6-12 wks
- Fatigue
- Quickening
sensation of fetal movement-16-20 wks

3

What are probable signs of pregnancy?

both you and your doctor think you are pregnant

4

What are some examples of probable signs of pregnancy?

- Cervical changes
Goodell’s sign: softens –by 5 wks
Chadwick’s sign: bluish colour of mucus membranes - 6-8 wks
Hegar’s sign: softening of the isthmus- 6-12 wks
- Positive pregnancy test to detect hCG
serum & urine tests usually 4-12 weeks
hCG- begins day of implantation ; levels detectable by day 7-10
Usually urine tests for OTC
- Braxton –Hicks contractions – 16 wks
- Ballottement- 16-28 wks; passive fetal movement

5

What is Goodell's sign?

cervical softening apparent by 5 weeks

6

What is Chadwick's sign>

bluish colour of mucus membranes - 6-8 wks

7

What is Hegar's sign?

softening of the isthmus (constricted part of the uterus between the cervix and body of uterus)

8

When does hCG start being produced?

day of implantation; detectable by day 7-10

9

When do braxton hicks contractions begin?

16 weeks

10

What is ballottement

a sharp upward pushing against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling the return impact of the displaced fetus
- done at 16-28 weeks

11

What are positive signs of pregnancy?

When you and your doctor know you are pregnant

12

What are some examples of positive signs of pregnancy?

- Fetus visible by ultrasound- 5 weeks
- Fetal sac can be seen by 5 weeks
- Fetal heart movement by 5-6 weeks
- Fetal heart tones heard by 5 weeks by ultrasound
- Fetal heart tones heard by Doppler- 8- 17 wks
- Fetal movements palpated- 19-22 wks

13

Who's rule do you use to estimate the babies date of birth?

Nagele's rule
EDB= LMP-3m+372 days

14

What are 3 abbreviations for babies due date?

EDC
EDD
EDB

15

How long does pregnancy last?

- lasts 9 months
- 10 lunar months
- 40 weeks

(counted from day of last menstrual period)

16

What is hCG?

- human chorionic gonadotropin
- is earliest biochemical marker of pregnancy
- Secreted by the trophoblast
- ensures early high levels of estrogen and progesterone
- Maintains these hormones until the placenta takes over

17

What is estrogen responsible for?

- produced by the placenta by 7 weeks
- responsible for enlargement of uterus, breasts, genitals
- relaxes pelvic ligaments and joints
- promotes water and sodium retention
- nasal congestion and stuffiness

18

What is progesterone responsible for?

- maintains pregnancy by promoting uterine muscle relaxation
- stimulates uterine growth
- Inhibits uterine contractions
- Relaxes smooth muscle

19

What is oxytocin responsible for?

- stimulates uterine contractions
- stimulates milk let-down reflex

20

What is prolactin responsible for?

responsible for initial lactation

21

What are 5 hormones of pregnancy?

- hCG
- Estrogen
- Progesterone
- oxytocin
- prolactin

22

What changes occur to the renal system during pregnancy?

Anatomical changes:
• Wk 10 the renal pelvis and ureters dilate
• Ureters elongate and become tortious and form single or double curves
• Volume of urine held increased while output volume decreases
• Bladder irritability
• Bladder displaced during second trimester

Functional changes:
• Glomerular filtration rate + renal plasma flow increased due to hormones, blood volume increases, posture, activity, + nutritional intake
• Renal function is effected by body position

Fluid & electrolyte balance
• extra sodium is usually retained during pregnancy to meet fetal needs
• physiological (dependent) edema caused by pooling of fluid in legs
• proteinuria normally occurs during birth & post partum
• Glucosuria (tubular reabsorption)- glucose levels below 7mmol/L

23

What changes occur to the GI system during pregnancy?

• woman’s appetite and food intake fluctuates (cravings)
• Gums become hyperemia, spongy, and swollen (watch for poor dental hygiene
• Esophageal regulation, stomach emptying decreases, heart ? due to decreased motility of the muscles
• Constipation due to increased progesterone (causes increased water absorption from colon)
• Distended gall bladder causes increased emptying time and thickening of bile
• Retention of bile in liver caused by factors withing the liver may result in pruritus gravidarum (severe itching) with or without jaundice
• Pelvic pressure, round ligament tension, flatulence, distention and bowel cramping
• Appendix is displaced upward and laterally, high and to the right

24

What physiologic adaptations occur to te respiratory system during pregnancy?

• Maternal oxygen requirements increase due to accelerated metabolic rate (Added tissue mass in uterus, breasts and fetus require oxygen and carbon dioxide to be eliminated)
• Elevated estrogen levels cause ligaments of rib cage to relax, and allow chest expansion
• Chest breathing replaces abdominal breathing ??
o Hyperventilation results from this; this increased respiration elevates blood pH so body goes into compensatory respiratory alkalosis
• Upper respiratory tract becomes more vascular in response to estrogen
o More blood being pumped; lining of airway receives more blood and swells; narrowing airway causes congestion
o Diaphragm elevates
o Chest expansion

25

What kinds of physiological adaptation to the cardiovascular system occur during pregnancy?

• Increased blood volume
• Increased cardiac output
• Changed position of heart
• b/w 14-20 wks, pulse increases 10 to 15 bpm
• an experience sinus arrhythmia(normal variation in the beating heart
• BP: diastolic pressure decreases from 1st trimester until 24-2 wks; returns to normal levels by term
• Supine hypotension syndrome (systolic pressure decreases more than 30 mmHg)
• BV increases 1500ml (40-50% above non pregnancy levels); increased plasm to RBC ration and decreased hematocrit
• Slight cardiac hypertrophy

26

What kinds of physiological adaptation to the integumentary system occur during pregnancy?

• Hyperpigmentation
• Darkening of nipples, vulva, areolae opportunity endeavors
• FaCH Melasma???: blotchy brownish hyperpigmentation of the skin, over ceeks nose and forehead
• Linea nigra
• Vascular spiders
• Pinkish-red blotches on palmar surfaces
• Itching of the skin
• Gums hypertrophy (gingital granuloma: gravid are …??
• Nail growth increses or nails become thinner and softer
• Hirstutiam (excessive growth of hair)
• Increases perspiration
• Oily skin and acne can occur or other woman have clear skin

27

What kinds of physiological adaptation to the neurological system occur during pregnancy?

• Compression of pelvic nerve causes sensory changes in legs and enlargement of uterus causes vascular stasis
• Compression of nerve roots causes pain from dorsal lumbar
• Carpal tunnel syndrome occurs from edema of peripheral neres during 3rd trimester; the syndrome characterized by abnormal sensation such as burning or tingling sensations; the pain in the hand radiates to the elbow
• Acroesthesia- numbness and tingling causes by stooped shoulder stance
• Headache caused by anxiety or uncertainty (vision problems)

28

What need to be covered at the prenatal visits?

Comprehensive health history
- current pregnancy and previous pregnancies
- OBS hx (can use GTPAL), medical hx (can cause complications)
Menstrual hx, contraceptive use, hx of infertility
hx, nutritional hx, social hx, emotional situation

29

What type of physical assessment would need to be done?

ht., wt., VS, pelvic exam

30

What diagnostic testing is necessary?

HgB, Hct, blood group, Rh factor (blood compatibility), GBS, rubella titer, urinalysis, blood sugar
screen for STI’s: HIV, HBV, syphilis, chlamydia, gonorrhea, HSV