7 signs of pregnancy
1) Chadwick's sign; 2) Goodell's sign; 3) Ladin's sign; 4) breast swelling and tenderness; 5) development of the linea nigra from umbilicus to pubis; 6) telangiectasias; 7) palmar erythema
4 sxs of pregnancy
1) amenorrhea; 2) n/v; 3) breast pain; 4) quickening - fetal movement
bluish discoloration of vagina and cervix
softening of the uterus after 6 weeks
softening and cyanosis of the cervix at or after 4 wks
What are peak levels of b-HCG in a pregnant woman and when does this occur?
100,000 mIU/ml at 10 wks
b-HCG levels in the 3rd trimester:
decrease from peak and level off at 20,000-30,000
How do u confirm dx of pregnancy?
How early and at what bHCG levels may you see the gestational sac on US?
at 5 wks or bHCG 1500-2000
How early and at what bHCG levels may you see the fetal heart on US?
at 6 wks or bHCG 5000-6000
conceptus from fertilization to 8 wks
conceptus from 8wks to birth
12-24 to 28 wks
24 to 28wks - birth
infant delivered at <24 wks
infant delivered btw 24-37 wks
infant delivered btw 37-42 wks
Definition: postdate/ postterm
infant delivered after 42 wks
the number of times a woman has been pregnant
the number of pregnancies that led to a birth beyond 20 wks GA
Definition: gestational age
the age of a fetus in wks and days measured from the first day of LMP; = DA + 2 wks
Definition: developmental age
age of a fetus in wks and days measured from date of fertilization
Is gestational age greater or less than developmental age?
LMP - 3mos + 7days
Exact dating of pregnancy
LMP + 280days
Definition: estimated date of confinement (EDC)
estimated date of delivery (EDD)
What is the acceptable discrepancy btw US and LMP dating by trimester?
1st: 1wk; 2nd; 2wks; 3rd: 3wks
What is the most accurate means of dating in the first half of the first tm?
crown rump length
How accurate is crown rump length in dating fetus in first tm?
within 3-5 days
At what time can you start to detect fetal heart sounds by doppler US?
When does quickening begin to occur?
Changes during pregnancy: CO
increases by 30-50%
Changes during pregnancy: BP
decrease in systolic (5-10mmHg) and diastolic (10-15mmHg) that nadirs at 24 wks followed by slow return to prepregnancy levels at term
Changes during pregnancy: SVR
decreases --> fall in arterial BP
Changes during pregnancy: tidal volume
increases by 30-40%
Changes during pregnancy: total lung capacity
decreases by 5% (due to elevation of diaphragm)
Changes during pregnancy: minute ventilation
increase in Vt with constant respiratory rate increases minute ventilation by 30-40%
Changes during pregnancy: PaO2
Changes during pregnancy: PaCO2
decreased (from 40mmHg to 30mmHg)
Cause of drop in BP during pregnancy:
elevated circulating progesterone levels
Common pulmonologic sxs during pregnancy:
What percentage of pregnant women will experience morning sickness?
Cause of morning sickness:
elevated levels of: 1) estrogen; 2) progesterone; 3) hCG
At what point should n/v resolve during pregnancy?
14-16 wks gestation
2 causes of esophageal reflux during pregnancy
1) prolonged gastric emptying times; 2) decreased tone of GES
Cause of bloating and constipation during pregnancy:
decreased motility of the bowel
Changes during pregnancy: GFR
increases by 50%
What change in the kidneys during pregnancy leads to increased rates of pyelonephritis?
kidneys increase in size --> ureters dilate
Changes during pregnancy: BUN
decrease by 25%
Changes during pregnancy: creatinine
decrease by 25%
Changes during pregnancy: aldosterone
increase secondary to activation of RAAS
Effect of increased aldosterone levels during pregnancy
increased sodium resorbtion
Why do plasma sodium levels remain normal throughout pregnancy?
because of the simultaneous increase in GFR
Changes during pregnancy: plasma volume
increases by 50%
Changes during pregnancy: rbc volume
increases by 20-30%
Changes during pregnancy: Hct
Changes during pregnancy: WBC
increases to mean of 10.5
WBC count during labor
can increase to >20
Changes during pregnancy: platelets
slight decrease (100, 000 - 150,000)
Estrogen production during pregnancy:
maternal adrenal glands produce estrogen precursors --> converted by placenta to estrogen
What organ produces hCG?
Function of hCG
maintains progesterone production by the corpus luteum
Doubling time of hCG during early pregnancy
every 48 hrs
What organ produces human placental lactogen( hPL)?
General function of hPL
ensures constant nutrient supply to the fetus
Another name for hPL
human chorionic somatomammotropin (hCS)
Specific functions of hPL
1) lipolysis --> increases circulating FFAs; 2) insulin antagonist --> diabetogenic effect (increased insulin levels and protein synthesis)
Which organ produces progesterone during pregnancy?
early pregnancy: corpus luteum; later pregnancy: placenta
General fxn of progesterone:
relaxation of smooth muscle
Name 2 skin changes that occur during pregnancy secondary to increased estrogen levels:
1) spider angiomata; 2) palmar erythema
Name 5 areas which become hyperpigmented during pregnancy
1) nipples; 2) umbilicus; 3) abdominal midline; 4) perineum; 5) face
What is the cause of skin hyperpigmentation during pregnancy?
increased levels of alpha-melanocyte stimulating hormone
Healthy weight gain during pregnancy
Name 4 nutrients which are required in larger amounts during pregnancy:
1) protein; 2) iron; 3) calcium; 4) folate
At what gestational age should the initial visit occur?
btw 6 to 10 wks
First trimester routine tests:
urine pregnancy test (if pt uncertain) + 1) Hct (CBC) 2) blood type and screen; 3) rapid plasma regin (RPR), 4) rubella Ab screen; 5) HepBsAg ; 6) gonorrhea Cx; 7) chlamydia Cx; 8) Pap smear; 9) UA and UCx; 10) VZV Abs (if no h/o chix pox); 11) HIV offered
Second trimester routine tests:
1) MSAFP/ triple screen; 2) ultrasound; 3) amniocentesis in AMA pts
Third trimester routine tests:
1) Hct; 2) RPR; 3) GLT; 4) repeat gonorrhea and chlamydia; 5) CXR if PPD+; 6) IP GBS Cx