Estrogen
secreted originally by the corpus luteum, is produced primarily by the placenta as early as the 7th week of pregnancy. Stimulates uterine development to provide a suitable environment for the fetus, also helps to develop the ductal system of the breasts i
Progesterone
produced initially by the corpus luteum and then by the placenta, plays the greatest role in maintaining the pregnancy; maintains the endometrium and inhibits spontaneous uterine contractility, thus preventing early spontaneous abortion; also aids in the
Relaxin
inhibits uterine activity, diminishes the strength of the uterine contractions, aids in the softening of the cervix and has long-term effects of remodeling collagen; produced by the corpus luteum, the placenta and uterine deciduas
HCG (human choronic gonadotropin)
stimulates progesterone and estrogen production by the corpus luteum to maintain the pregnancy until the placenta is developed sufficiently to assume that function
diagnostic value: basis for pg test (most accurate 10-14 days after the last missed period)
Uterus
pear shaped organ that increases in size: from about 2ozs to 2.5 pounds_
capacity has increased from 10ml to 5000ml or more; by the end of pregnancy
increase in the total maternal blood volume is contained within the vascular system of the uterus
Braxton-Hicks contractions
the irregular, generally painless contractions of the uterus; occur intermittently throughout the pregnancy; may be confused with true labor in later pregnancy
Mucous Plug
formed by the endocervical glands secreting a thick sticky mucous that accumulates; this seals the endocervical canal and prevents the ascent of microorganisms into the uterus; expelled when cervical dilatation begins
Cervical os
closed except in multiparas (never completely closes after the birth of a child due to stretching with the birth process (maybe open a fingertip); at the time of labor expands from an opening of fingertip to 10cms to accommodate the birth of the baby
Goodell's Sign
softening of cervix at 4-6 weeks
Hegar's Sign
Softening of isthmus of uterus at 4-6 weeks
Chadwick's sign
Bluish tint to cervix and vagina due to increased vascularization at 4-12 weeks gestation
Vagina
estrogen causes a thickening of the vaginal mucosa and an increase in vaginal secretions;
o secretions are thick, white, and acidic; the acidic conditions help to prevent bacterial infections but favors the growth of yeast infections
TEACH: s/s of infecti
Ovaries
stop producing ova during pregnancy; the corpus luteum continues to produce to hormones until about 6-8 weeks; also continues to secrete progesterone until week 7 when the placenta takes over producing progesterone
Recommended Weight Gain
recommended weight gain during pregnancy: 25-35 pounds (for women of normal weight before pregnancy)
women who are overweight before pregnancy: the recommended weight gain is:15-25 pounds.
women who are underweight: the recommendation is: to gain weight t
Weight Gain during pregnancy
Weight gain in pregnancy: 1st trimester---3.5-5 pounds (many women lose weight during the 1st trimester)
2nd trimester�1 pound/week
3rd trimester---1 pound/week
for twins the weight gain per week is _1.5 pounds/week in the 2nd and 3rd trimester
Inadequate
Carbohydrates and Pregnancy
body's primary source of energy as well as fiber; if too low the body resorts to protein for energy consumption which means less available for growth; carbohydrates need to increase during the 2nd and 3rd trimester; the fetus doubles its weight in the las
Protein and Pregnancy
supplies the amino acids necessary for growth of the uterus, breasts, and the fetus; greatest demand during the last trimester increase to maintain a constant level for breast milk production;
Increases to 60g/day (up 14g/day from non-pregnant)
Examples o
Calcium and phosphorus and Pregnancy
involved in the mineralization of fetal bones and teeth; fetal teeth begin to form at 8 weeks gestation; fetal bone calcification occurs in last 2-3 months; recommended intake is 1000mg/day (4 cups of milk or its equivalent); if inadequate calcium intake:
Iron and Pregnancy
increase during pregnancy because of the growth of the fetus and placenta and expansion of maternal blood volume; inadequate intake or depleted stores of iron in the body results in anemia; also related to an inadequate intake of Vitamin B, and folic acid
Foods to avoid in pregnancy
o Shellfish, swordfish, shark, mackerel (high levels of mercury)
o Albacore tuna (high levels of mercury); most canned tunas OK in moderation
o Soft cheeses like brie (listerosis)
o Lunch meats/deli meats (discard after 3-4 days due to risk of listerosis)
Normal H&H values of Pregnancy
o iron is necessary for hemoglobin formation (hemoglobin is the oxygen carrying component of RBCs)
? normal hematocrit levels during pregnancy: 32-42% (non-pg=37-47%)
? normal hemoglobin levels during pregnancy: 10-14mg/dl (non-pg: 12-16 g/dl)
chloasma
increased in darkening of the skin over the cheeks, nose and forehead; more prominent in dark-haired women (also known as the "mask of pregnancy") aggravated by exposure to the sun; fades after childbirth when hormonal influence returns to normal
vascular "spiders" nevi
small bright red elevations of the skin radiating from a central body; may develop on the neck, face, arms and legs; caused by increased subcutaneous blood flow in response to elevated estrogen levels
Couvade
the observance of certain rituals and taboos by the male to signify the transition to fatherhood (in some cultures certain rites must be followed) in the US it describes the unintentional development of physical symptoms such as fatigue, increased eating,
Prenatal management and Nursing care during the prenatal period
if no complications: need to see healthcare provider at least once/month (every 4 weeks) following initial visit (at 8-12 weeks) until week 32
then every 2 weeks until week 36
then every week until delivery; if overdue may see physician twice a week with
Antepartum Testing
Bloodwork:
o rubella titer (immune or non-immune)
o blood typing
o CBC (complete blood count): H&H level (norm for pregnancy: 32-42% hemoglobin and 10-14mg/dl hematocrit)
o hepatitis B screen
o illicit drug screen: done at initial screening and then done
Fetal Heart Rate Test
heard by Doppler between 10-12 weeks gestation
Fetal heart rate monitors:
� 1.fetoscope
� 2.doppler
� 3.electronic fetal monitor
Fetal kick counts
after about 27 weeks, laying comfortably on her side, approximately 1 hour after a meal
Count the number of times the baby kicks in 1 hour or after 4 movements (should feel at least 4 mvts/hour) and record
Nuchal Translucency scan
measures the amount of fluid in a baby's neck; done at 11-14 weeks gestation; calculations done using the fluid measurements, mom's age and presence or absence of baby nasal bone; done under ultrasound; checks for birth defects
Choronic villi-testing: (CVS)
performed between 9-11th week of pregnancy to check for chromosomal abnormalities; small amount of placental tissue removed from uterus using a catheter inserted through the cervix with ultrasound guidance; tissue is grown in a culture and then checked fo
Rh Blood tests
Antibody testing (indirect coombs) done through a blood sample at 28 weeks on all RH(-) moms if test is negative then she is given an IM injection of Rhogam/Rhophylac; also given following a CVS, amnio, ectopic pregnancy, miscarriage, abortion or within 7
PUBS (cord blood sampling
method used to transfuse a fetus in utero as follow-up to an ultrasound or an amniocentesis it is determined that the fetus is anemic; blood is given through the umbilical cord; done after 17 weeks; also used to identify malformations of the fetus and to
Diabetic screening
between the 24th-28th week of pregnancy the mother drinks a sugary drink (glucola) and then blood is drawn (glucose tolerance test) to check for gestational diabetes; (NOTE: normal FBS: 59-97mg/dl)
� Action: if level greater than 164mg/dl after 1 hour of
Beta Strep Test
culture of the cervical area to check for the presence of strep B infection between the 32-36th week gestation for all pregnant women; + culture signifies exposure to the organism; most prevalent in teachers and healthcare workers
� Action: mom treated wi
AFP
blood test that tells if there is an increased risk of neural tube defects, down's syndrome or certain chromosomal abnormalities; drawn between 16-18 weeks gestation; checks the level of alpha fetal protein, estriol and HCG levels;
� Action: if AFP low (e
Amniocentesis
transabdominal placement of a needle into the amniotic cavity for the purposes of aspirating or injecting fluid; after 14th week of gestation for the purposes of:
� 1. assessment of fetal maturity prior to an induction/csection before 38 weeks gestation
�
Estriol assays
index of placental functioning or sufficiency and fetal well being; estriol is produced by fetal adrenals, processed by placenta and excreted by maternal kidneys; levels increase as pregnancy progresses
� serial studies are begun about week 34;
� adequate
OCT (oxytocin challenge test):
determination of FHR in response to uterine contractions
� 1.woman is hospitalized; FHR baseline is determined and recorded
� 2.oxytocin induction is initiated: IV drip initiated and regulated until 3 contractions in 10 minutes
� 3.oxytocin is then discon
NST: non stress test
� test conducted on an out patient basis; performed in the same manner as the OCT except contractions are NOT stimulated; looks at FHR in response to fetal movements and/or uterine contractions
� considered "reactive" : 3 accelerations of the FHR in a 10
Fetal blood sampling
have to have ruptured membranes; engaged vertex presentation; and cervical dilatation
� signs of fetal distress:
� 1. pH below 7.20 (normal is 7.3-7.4)
� 2. increased arterial PCO2
� 3. decreased arterial PO2
� Usually will also see changes in the FHR on
Biophysical profile
ultrasound done with a score assigned from 0 to 2 for these areas:
� 1. fetal breathing mvts.
� 2. reactive fetal heartrate (NST)
� 3. fetal tone (is baby flexed or extended)
� 4. gross body mvts
� 5. qualitative amniotic fluid volume
Gravida
a pregnant woman; the number of times a woman has been pregnant
Para
refers to the number of pregnancies that have reached the point of viability, whether or not the infants were born alive (point of viability is 20 weeks)
Preterm
is the number of infants born after 20 weeks and before 37 weeks gestation
Term
infant born after 37 weeks gestation
Probable Signs of Pregnancy
an examiner's objective findings; do not conclusively confirm a pregnancy
changes in the pelvic organs: (caused by increased vascular congestion)
Goodell's sign: softening of the cervix
Chadwick's sign: bluish or purplish discoloration of the mucous membr
Positive signs: definitive signs of a pregnancy
fetal heartbeat:
fetal movement that is actively palpable by examiner at about 20+ weeks of pregnancy
visualization of the fetus by ultrasound
Estimation of length of pregnancy: Nagele's Rule
The estimated date of confinement (EDC) is calculated by noting the first day of the last menstural period (LMP) and counting back 3 months (minus 3 months) and adding 7 days based on a 28 day cycle
o if a shorter cycle then subtract the number of days sh