1. What is antepartum? a. Pertaining to the time during pregnancy before the onset of labor 2. Probable, presumptive, positive signs of pregnancy. Presumptive indications: indications that are subjective changes that are experienced and reported by the women. Least reliable when confirming pregnanc...
UNRS 402 OBFinal Exam Study Guide
ANTEPARTUM
1. What is antepartum?
a. Pertaining to the time during pregnancy before the onset of labor
2. Probable, presumptive, positive signs of pregnancy.
Presumptive indications: indications that are subjective changes that are experienced and reported by the
women. Least reliable when confirming pregnancy; can be caused by conditions other than pregnancy
a. Amenorrhea: absence of menstruation
b. Nausea and vomiting:60-80% of women experience N/V. Beginning at 4-8 weeks and usually
ending at 10-12 weeks Your text here 1
c. Fatigue: fatigue and drowsiness during the first trimester; cause unknown (hormone changes
possible)
d. Urinary frequency: results from hormonal and fluid volume changes
e. Breast and skin changes: breast changes begin by 6th week-breast tenderness, tingling, fullness,
increased size and pigmentation of areolae. Increased pigmentation of skin resulting from
estrogen and progesterone on melanocytes
f. Vaginal and cervical color change: Chadwick sign is one of the earlies signs of pregnancy-
Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of
increased vascular congestion
g. Fetal movement: not until second trimester. 16-20weeks.
Probable indications: objective findings documented by examiner
h. Abdominal enlargement
i. Cervical softening: noted during pelvic exam
j. Changes in uterine consistency
k. Ballottement: tap on cervix during vaginal exam may cause the fetus to rise in the amniotic fluid
and then rebound to its original position
l. Braxton Hicks contraction
m. Palpation of the fetal outline
n. Pregnancy tests: detect hCG which is secreted by placenta and present in maternal blood and
urine
Positive indications
o. Auscultation of fetal heart sounds: heart sounds can be heard with a fetoscope by 18 – 20 weeks.
Doppler is used to detect heart motion and makes audible sound by 9 – 12 weeks
p. Fetal movements felt by examiner: considered a positive sign; not to be deceived by peristalsis in
large intestine
q. Visualization of the fetus: ultrasonography-view the embryo or fetus and observe the fetal
heartbeat
3. Normal pregnancy labs
a.
,UNRS 402 OBFinal Exam Study Guide
b.
4. Missed, threatened, incomplete, inevitable abortion.
a. Abortion: loss of pregnancy before the fetus is viable, or capable of living outside the uterus
b. Symptoms:
i. Bleeding
ii. Cramping
iii. Loss of pregnancy symptoms
(Matching question)
c. POC-products of conception
d. D&C-dilation and curettage (surgery that dilates the cervix and cleans out the uterus)
Spontaneous Abortion (SAB): termination of pregnancy without action taken by the woman or another person
e. Common cause is severe congenital abnormalities that are often incompatible with life
i. Threatened abortion: the cervix is not dilated, and the placenta is still attached to the
uterine wall, but some bleeding occurs.
1. The baby is still alive. The bleeding might resolve with bedrest, and she might be
able to continue the pregnancy, but a miscarriage is a possibility.
ii. Imminent/Inevitable abortion: the placenta has separated from the uterine wall,
the cervix has dilated, and the amount of bleeding has increased.
1. There is so much bleeding that a miscarriage is inevitable, it can’t be stopped. The
baby still has a heartbeat
a. Vacuum curettage: removal of uterine contents with a vacuum curet- to
clear uterus if natural process is ineffective or incomplete
b. Dilation and curettage (D&C): stretching the cervical os to permit
suctioning or scraping the uterine walls- if pregnancy is more advanced or
if bleeding is excessive
iii. Incomplete abortion: the embryo/fetus has passed out of the uterus; however, the
placenta remains
1. Priority intervention-start an IV for fluid replacement and drug administration
2. D&C (may not be performed if the pregnancy has advanced beyond 14 weeks-
danger of excessive bleeding)
iv. Complete abortion: all products of conception are expelled from the uterus and
uterine contractions and bleeding subside, and the cervix closes
1. No additional intervention required
2. Watch for excessive bleeding
,UNRS 402 OBFinal Exam Study Guide
v. Missed abortion: the fetus dies during the first half of the pregnancy but is
retained in the uterus
1. Ultrasound exam confirms fetal death
2. Pregnancy tests for hCG should show decline in placental hormone production
3. D&C is performed, D&E for second trimester
vi. Recurrent spontaneous abortion: three or more spontaneous abortions
(sometimes defined as two or more pregnancy losses)
1. Primary cause is believed to be genetic or chromosomal abnormalities and
anomalies of the reproductive tract
5. TPAL
a. Pregnancy history
b. G – Gravida (total # of pregnancies)
c. P – Para (total births)
i. Twins count as 1 pregnancy and 1 birth
d. TPAL
i. T – Term (>37 weeks gestations at birth)
ii. P – Preterm (20 – 37 weeks at birth)
iii. A – Abortions (spontaneous or elective/induced <20 weeks)
iv. L – Living children
6. Plasma volume in pregnancy
a. Changes in Cardiovascular:
b. Plasma volume increases from 6 to 8 weeks until 32 weeks of gestation
i. 40% - 60% (1200 to 1600 mL) greater than nonpregnant women
1. Increase is higher in multifetal pregnancies
c. Reason for increase unclear – may be related to vasodilation from nitric oxide, and estrogen,
progesterone, and prostaglandin stimulation of RAAS which causes sodium and water retention
d. Increased volume is needed to:
i. Transport nutrients and oxygen to the placenta, where they become available for the
growing fetus
ii. Meet the demands of the expanded maternal tissue in the uterus and breasts
iii. Provide a reserve to protect the pregnant woman from the adverse effects of blood
loss that occurs during childbirth
e. Red blood cell volume:
i. Increases about 20% - 30% above prepregnancy values
ii. Both RBC and plasma volume expand, increase in plasma volume is more
pronounced and occurs earlier
1. Resulting dilution of RBC causes decline in maternal hemoglobin and hematocrit
2. Physiologic anemia of pregnancy or pseudoanemia of pregnancy
a. Reflects dilution of RBCs in the expanded plasma volume rather than an
actual decline
7. Fundal height during pregnancy.
a.
, UNRS 402 OBFinal Exam Study Guide
8. Naegele’s rule
a. EDC/EDD/EDB
b. Subtract 3 months from the first day of the menstrual period and add 7 days
9. Oligohydramnios
a. Volume of amniotic fluid is approximately 700 to 800 ml at 40 weeks
b. Oligohydramnios: Less than 50% or 400 mls at term. May be associated with:
i. Poor placental blood flow
ii. Preterm membrane rupture
iii. Failure of fetal kidney development
iv. Blocked urinary excretion
c. Poor fetal lung development (pulmonary hypoplasia) and malformations such as skeletal
abnormalities may result from compression of fetal parts.
10. Purpose of tocotransducer
a. Uterine activity monitoring
i. Pressure-sensitive area detects changes in abdominal contour to measure uterine activity
b. Uterus pushes outward against the mother’s anterior abdominal wall with each contraction
i. The monitor calculates changes in this signal
c. Maternal respirations cause uterine activity line to have a zigzag appearance
d. Useful for observing the frequency and duration of contractions; does not measure intensity and
uterine resting tone
e. Factors that affect apparent intensity as printed on strip:
i. Fetal size: uterus will not push firmly against abdominal wall when fetus is small;
contractions appear less intense
ii. Abdominal fat thickness: thick layer of abdominal fat absorbs energy from
contractions, reducing apparent intensity on printed strip. Palpation with fingertips may
help clarify intensity externally
iii. Maternal position: different positions may increase or decrease pressure against
transducer, changing apparent intensity
iv. Location of the transducer: uterine activity is best detected where it is strongest
and where the fetus lies close to uterine wall. Usually over the fundus
11. Effects of teratogens.
a. Agents in the fetal environment that cause or increase the likely hood that a birth defect will
occur
b. Typically cause more than one defect
c. Types of teratogens:
i. Illicit drugs and alcohol
ii. Medications
iii. Infections agents that cross the placenta (viruses, bacteria, etc.)
iv. Tobacco
v. Pollutants, chemicals, and other substances the mother is exposed to in daily life
vi. Maternal hyperthermia
vii. Effects of maternal disorders: diabetes mellitus and PKU
12. Purpose of folic acid supplement.
a. Evolve Question: Women of childbearing age should take at least 0.4 mg of folic acid daily to
prevent neural tube defects if a pregnancy occurs
b. Essential throughout pregnancy but especially during the first 8 weeks
c. Maternal: deficiency may contribute to iron deficient anemia
d. Fetal: can cause neural tube defects (spinal bifida) and spontaneous abortion
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