RNSG2910 Mrs. T. Bryant OB
3-1-0-1-0
3 times pregnant
1 term pregnancies
0 preterm
1 abortion
0 living children
Ex: A women is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system?
Example 13-1
Preterm:
pregnancy that has reached 20 weeks of gestation but before completion of 37 weeks of gestation
Primipara
woman who has completed 1 pregnancy with a fetus or fetuses who have reached stage of fetal viability
Viability
: capacity to live outside the uterus- no clear limits of gestational age- 22 to 25 weeks gestation are considered to be on the threshold of viability.
Human chorionic gonadotropin (hCG)
is earliest biochemical marker for pregnancy
Production begins as early as day of implantation
Can be dated 7 to 10 days after conception
Unusually high results can indicate a ectopic pregnancy or down syndrome.
If goes up = etopic preg or down syndrome
Radioimmunoassay tests
(RIA) pregnancy , Use radioactively labeled markers to detect anti-bodies against hCG in blood or urine
More accurate before missed period
test for beta sub units
MORE accurate than RRA
Radioreceptor assay (RRA)
tests for binding
6-8 days after conception
Used to detect very small amounts of hCG such as in ectopic pregnancy.
Enzyme-linked immunosorbent assay (ELISA)
*NTK
The test used to in the over the counter medication to identify the HCG component is known is the ELISA.
Many pregnancy tests available:
NTK *It is very important to ask women if they are taking any medications such as anticonvulsants and tranquilizers that can give false positives
diuretics and promethazine can give false negative.
Presumptive signs
Changes felt by woman:
Amenorrhea- no periods
Fatigue
Nausea
Vomiting
Breast changes
NOT SIGN OF PREGNANCY
Positive signs
Signs that are attributable only to the presence of a fetus:
Hearing fetal hear tones- pg. 292 TABLE 13-2
Visualization of the fetus
Palpating fetal movement -16-20 WEEKS
Adaptations to Pregnancy
Signs of pregnancy
Reproductive system and breasts
Uterus
Changes in size, shape, and position
Changes in contractility
Uteroplacental blood flow
Cervical changes
Uteroplacental blood flow-
NTK*** 1/6 th of the total maternal blood volume is within the uterine vascular system. Can hear two sounds the uterine souffle sound made by blood in the uterine arteries that is synchronous with the maternal pulse and the funic souffle sound made by blood rushing through the umbilical vessels and synchronous with the fetal hear rate.
uterus growth
Uterus- 7 weeks sixe of egg, 10 weeks - size of orange, 12 weeks sixe of grapefruit, and third month uterine enlargement and pressure of fetus starting.
Average growth - 22-24 wks at umbilicus
Xiphoid process at term
38-40 weeks fundal height will drop or known as lightening.
Doctors will measure fundal height at each visit.
lightening
the process or time during late pregnancy when the fetal head begins to descend into the mother's pelvis, resulting in a lessening of pressure on the diaphragm. 38-40 weeks
fundal height
With McDonald's method, the gestational age is estimated to be equal to the _________ __________.
quickening
the stage of pregnancy at which the mother first feels movements of the fetus; flutter (when this is felt it helps to date pregnancy)
Uterus S/S
―continued
Changes related to presence of fetus
Quickening - Vagina and vulva
Chadwick sign ( violent bluish color of the vaginal mucosa and cervix)
Leukorrhea ( white or gray mucoid discharge with a faint musty odor will increase) r/t to cervical stimulation by estrogen and progesterone.
OPERCULUM
mucous plug
abt length of index finger
keeps cervix from dilating
labor 24-48 hours will start
Breasts S/S
Montgomery tubercles hypertrophy of the sebaceous glands embedded in the primary areolae. This helps in keeping the nipples lubricated during breastfeeding.
Colostrum - the creamy - white to yellowish to orange pre-milk fluid may be expressed as early as 16 weeks.
Lactation will be inhibited until after the birth r/t to estrogen levels.
Cardiovascular S/S
Blood pressure ( be sure use right size cuff, same position)
Blood volume and composition ( increases by 1500ml)
Cardiac output ( output increases by 30 to 50%)
Circulation and coagulation times ( circulation time decreases slightly by week 32. and returns to normal close to term this increase risk for clots)
See table 14-4
Slight cardiac hypertrophy
is probably related secondary to the increase in blood volume and cardiac output that occurs. The heart will return to its normal size after childbirth. It is usually rotated forward and to the left because of the displacement of the diaphragm during pregnancy.
Between 14 and 20 weeks
the pulse may increase by 10 to 15 beats which will continue till term.
Normal response.
Respiratory system
( table 14-5)
Pulmonary function ( O2 requirements increase)
Diaphragm displaced by at least 4 cm.
Basal metabolism rate ( increases )
Acid-base balance
The upper respiratory system
becomes more vascular related to increase in estrogen. This can cause nasal congestion, epistaxis, changes in voice and marked inflammatory response.
Renal system ( results from changes in hormonal activity)
S/S
Anatomic changes ( dilatation of ureters - holds larger amounts of urine and but flow rate is slower)
See consequences on page 300
Functional changes (most effected if lies in the recumbent position, needs to lie on side)
Fluid and electrolyte balance - (retain about 500 to 900 sodium
during pregnancy to meet fetal needs)
Proteinuria
Proteinuria
NTK***** does not occur in normal pregnancy except during labor or after birth However, because of filtering capacity there may be a trace ( 1+protein or 300mg per 24hr are acceptable during the pregnancy)
probably has
normal s/s
changes in voice
nosebleeds
visual
growth of feet
due to increase in vascularity and estrogen
Integumentary system S/S
Chloasma ( mask of pregnancy - usually fades after birth)
Linea nigra ( pigmented line that runs vertically up the abdomenn)
Striae gravidarum - ( stretch marks)
Palmar erythema- ( pinkish red blotches on the hands)
Striae gravidarum
Irregular pink to purple streaks on the abdomen, breasts, or thighs resulting from tears in the connective tissue.
Gastrointestinal system S/S
Appetite ( fluctuates - Cravings)
Mouth ( gums becomes hyperemic, spongy and swollen)
Esophagus, stomach, and intestines ( hiatal hernia, peptic ulcers, slower emptying time)
Gallbladder and liver ( distended gallbladder may occur)
Abdominal discomfort
Endocrine system
Pituitary and placental hormones
Thyroid gland ( enlarges)
Parathyroid gland
Pancreas ( maternal glucose levels decrease) however, by delivery there will be a added demand for insulin.
Adrenal glands
HCG maintains
the production of corpus luteum until the placenta takes over production.
Progesterone essential for maintaining pregnancy
Oxytocin
NTK*** is produced by the posterior pituitary gland assist with labor and stimulates the let down or milk ejection reflex
Biochemical, physiologic, and anatomic adaptations
that occur during pregnancy revert to the nonpregnant state after birth and lactation
are attributed to the hormones of pregnancy
Maternal adaptations
are attributed to the hormones of pregnancy and mechanical pressures exerted by enlarging uterus and other tissues
Nullipara:
woman who has not completed pregnancy with a fetus or fetuses who have reached the stage of fetal viability