*What size is the non-pregnant uterus?
about the size of a pear
*What changes occur to the pregnant uterus?
Increase in size and weight due almost entirely to hypertrophy of the myometrial layer of the uterus
*What blood and lymphatic changes occur to the uterus during pregnancy?
The size and number of blood and lymphatic vessels increases. 1/6 of maternal blood volume is contained within the vascular system of the uterus. Blood volume increases by 40-50%. Pregnant and laboring women are at risk for shock if the placenta is disrupted.
softening of the cervix. Occurs at 6 weeks.
blue- purple discoloration of cervix and vagina. Occurs at 8 weeks.
*How much does blood volume increase during pregnancy?
increases by 40-50%
*what change in hct/hgb do we expect during the 28-32 week ofpregnancy?
physiologic anemia. Normal value: Hct>36 hgb>11.
vitamin B6 (25 mg) plus antihistamine (doxylamine) 12.5 PO bid to qid. Can be mixed in compounding pharmacy.
Term (>37wks), preterm (20-36wks), abortion (<less than 20wks), living children.
What does G4P1113 mean?
Gravida 4 Para 1113= 4 pregnancies (includes current), 1 term, 1 preterm, 1 aborted, 3 living children. One of the pregnancies was twins.
*Should a glucose screen be done routinely during pregnancy? if so, when?
yes, at 26-28 weeks
*What is the most accurate way to predict a woman's due date?
Last menstrual period for those whose cycles are regular (28 days)
*How do you calculate the EDC (expected date of confinement) based on the first date of the last menstrual period?
Subtract 3 months, add 7 days and add a year if needed.
*When should CBC lab test be done?
26-28 weeks and 36 weeks.
If a woman's first day of LMP is 05/14/2011, what is the due date?
If a woman's first day of LMP is 01/31/2011, what is the due date?
If a woman's first day of LMP is 03/20/2011, what is the due date?
What should the fundus measure between weeks 20-37?
The same in centimeters within +/- 2 cm.
There should be growth of at least 1 cm per week.
What is the ideal presentation for delivery?
Left occiput anterior presentation.
How do you feel for the head's presentation in a vaginal exam?
Feel for the fontanelles in the baby's cranium. the Anterior fontanelle is a diamond shape, the posterior fontanelle is a triangle.
*What should you do before performing a pelvic examination?
Determine if the membranes are intact. Can cause infection.
Conditions prohibiting sex in pregnancy
High risk for miscarriage, vaginal bleeding (not unusual to spot), painful intercourse, signs of preterm labor, high risk of preterm labor (no nipple stimulation), herpes lesions (either partner), placenta previa, ruptured membranes.
*What is the recommended weight gain during pregnancy?
On average, 3.5 to 5 lbs during 1st trimester (12wks), 10 lbs at 20wks, 1lb per week for the 2nd and 3rd trimester.
*What is the recommended weight gain range for a woman with normal BMI (19.8-26.0)?
25-35 lbs. Women of short stature should gain the lower level of recommendation.
*How much protein should woman eat?
Pregnant: 60 gm/day
Lactating: 65 gm/day
*What is the recommended intake of folate during pregnancy?
400 mcg/day- 1000 mcg/day (according to some). 4 mg if previous infant with neural tube defect.
*How much dairy should pregnant woman eat?
4 cups a day
*How many servings of protein should a pregnant woman eat?
3 servings a day
*How many servings of grain products should a pregnant woman eat?
6-11 servings a day
*How many fruits and fruit juices should a pregnant woman have?
2-4 servings a day
*GDM screening, when and how?
26-28 weeks gestation. Glucose screen: 50 mg 1 hour. Results: Normal, no further testing<140. GDM, no further testing, administer insulin>200. 140<200=3 hr GTT (100gm glucola).
*What happens if a woman has n/v and/or can't eat during pregnancy?
Increased Ketone production, do not confuse with diabetes.
*When should Hct/Hgb be tested?
26 weeks. during 28-32 weeks, physiologic anemia of pregnancy will be present.
normal value: hct>36 hgb >12.
*Early spontaneous abortion
Before 12 wks. occurs in 50% of subclinical pregnancies. Occurs in 20% of clinically recognized pregnancies. Only 2% of pregnancies end in abortion after fetal heart tones are noted.
*Late spontaneous abortion
between 12-20 wks. Congenital abnormalities are the most common cause.
*Treatment for unruptured ectopic pregnancy
Methotrexate given (based on height and weight), causes death of rapidly dividing cells.
*What are the risks of performing vaginal exam?
May introduce bacteria. NEVER do in a woman after ROM! Group B strep is high risk(if positive, must deliver baby within 24 hrs of rupture.), and CMV.
Affects 5-10% of primiparas and 1% of multiparas. NO cure, only delivery. Generally occurs in third trimester. Runs in families, obesity increases risk.
vasospasm is the key process in the disease as well as an increased sensitivity to angiotensin which raises BP. This causes endothelial cell damage, platelet and fibrin adherence to damaged cell walls, increased vascular permeability=edema (in all organ systems, not visible). Will see increase in Hct with hemoconcentration!
BP: 140/90; proteinuria <300/24hr (+1 on dip stick); HA absent; visual disturbances: absent; upper abdominal pain: absent; oliguria: absent; serum creatinine: normal; thrombocytopenia: absent; liver function studies: normal; fetal growth: normal.
BP: 140/100-160/100 (not the criteria); proteinuria >300 mg/24hr; headache present; visual disturbances present; upper right abdominal pain present; oliguria <500 mL in 24 hr; serum creatinine elevated; thrombocytopenia <100,000 platelets; liver function studies: AST & ALT elevated; fetal growth decreased (IUGR), Risk of placental abruption high; edema marked (hands, legs, face), hyper-reflexia (DTR's >2+).
Seizures that cannot be attributed to other causes in a woman with preeclampsia. Extremely high maternal and fetal morbidity and mortality. MgSO4 effectively prevents this (given during labor is preeclampsia), delivery is the only cure. Safety of the mother during seizure is your primary responsibility. Maintain airway, position on side, side rails up, give O2.
Hemolysis, Elevated Liver enzymes and Low Platelet count. Associated with severe preeclampsia. s/s: n/v, malaise, flu-like symptoms, epigastric pain.
Occurs when an Rh negative mother is exposed to Rh positive blood (antigen) and has an immunologic antibody reaction. Theses is indirect coombs at 1st prenatal visit and 28 weeks. Rhogam coats the fetal red blood cells and prevents antibodies from becoming sensitized.
S/s: painless vaginal bleeding!!! occurs during late second and third trimester. More often, there is malpresentation of baby (breech or transverse), diagnosed by ultrasound.
*Bleeding woman >18 wks, vaginal exam?
NOT without confirmation via ultrasound of placental location!
How many fetal movements should a woman feel?
10 movements in 12 hours during low movement times, when fetus is active, should be 10 times in 1 hour.
*what should be done if woman reports decreased fetal movement during last trimester?
Send immediately for a non-stress test!
>32 weeks: 2 accelerations of 15 BPMs more than the baseline for 15+ secs within 20 minutes.
<32 weeks: 2 accelerations of 10 BPMs more than the baseline for 10+ secs within 20 minutes.
Once a mother has a reactive NST it should NOT become unreactive!
*what test will show if pregnancy is viable at 6 weeks if bleeding is present?
Ultrasound that confirms fetal heart beat.
*What is the most common cause of spontaneous abortion?