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What are the daily nutritional requirements for pregnancy?
- Protien 3xs, B12,
- Carbs 6xs, dairy 4x, fruit 2x, veggies 3x, green/deep yellow (vitamin C), Vitamin D, and Folic acid
1. What is normal weight gain for pregnancy?
2. What should you gain in the 1st 20 weeks?
3. What should you gain after 20 weeks?
- 1. 25-35 lbs
- 2. 10-13 lbs
- 3. 1lb per week
What is the break down of the weight gain?
- 11lbs- fetus, placenta, amniotic fluid
- 2 lbs- placenta
- 4 lbs- blood volume
- 3 lbs- breast tissue
- 5-10lbs of extra fat
What is PICA?
Abnormal craving- dirt, laundry soap, corn starch etc
What kind of meds are ok for Mom to take during pregnancy?
- Only prenatal vitamins
- Mom should medication free as possible!
What is a teratogenic effect?
Anything that can cause a physiological abnormalities in the fetus.
What does smoking, alcohol, and caffeine do to the fetus? (teratogenic effects)
- Smoking- vasoconstrictor, no blood supply, usually preemie, will have intrauterine growth restriction (IUGR)
- No caffeine- CNS stimulant- low birth weight
- Alcohol- the only preventable problem- physical defects, congenital defects, increased cognitive impairment, premature, placenta detaches, NICU
How much folic acid should a pregnant woman take each day?
How many months ahead of conception?
What birth defects happen if a woman is deficient?
- 400 mcg/day
- Take 3 months ahead of time,
- Prevents spinal bifida which is the failure for the spinal cord to seal together, the lower the sac comes out the more severe,
What does estrogen do?
stimulates uterine development to provide environment for fetal growth
What does HUMAN CHORIONIC GONADTROPIN (HCG) do?
- Produced by the placenta
- What is detected in a urine pregnancy test
- Beta HCG (the acutal amount of HCG circulating in your blood)- if suspected bleeding- bed rest- watch to make sure levels go higher and higher
What does HUMAN PLACENTAL LACTOGEN (HPL) do?
- promotes lipolysis
- Increases the resistance to insulin, facilitates glucose transport across the placenta
What does progesterone do?
- maintains the endometrium and inhibits uterine contractions
- If low, can’t get pregnant
What does PROSTAGLANDIN (lipids) do?
- associated with the onset of labor
- High concentration in pregnancy
- HTN in 1st trimester is related to prostaglandins
What does RELAXIN do?
- In the beginning inhibits contractions
- Near the end of pregnancy softens the cervix
What are the physiologic changes with the cardiovascular system in pregnancy?
- -Physiologic anemia (plasma volume increases 50% = 7% decrease in hematocrit)
- More plasma but RBCs are not able to produce as fast
What is Vena cava syndrome?
- Or called supine hypotension syndrome
- Placenta compresses the vena cava
- **LAY ON LEFT SIDE- w/ pillows, if baby doesn’t like lay on right side
What are the changes in the Cardiovascular system?
- Cardiac output 30-40%
- Increase of 10-15 beats per minute is normal
- Postural hypotension- uterus presses on pelvic & femoral arteries
What are the physiologic changes with the RESPIRATORY system in pregnancy?
- Nasopharyngeal edema
- -Upper respiratory tract becomes more vascular in response to increased estrogen
- -Capillaries become engorged- lead to edema in pharynx
- -Will have stuffy nose- normal- mild upper respiratory infection (URI)
- Shortness of breath
- -Hyperventilation – lower threshold for carbon dioxide – this is a change in the respiratory center in the brain – is caused by progesterone and estrogen
What are the physiologic changes with the RENAL system in pregnancy?
- If kidneys are not filtering will have gestational diabetes
- 7-10 years down the road the mother will have diabetes
- GFR ↑ 50% til delivery
- Urinary frequency
- 1st Trimester: Uterus presses on bladder = urinary frequency
- 2nd Trimester: Relieved by uterus moving into abdominal area
- 3rd Trimester: Urinary frequency as the presenting part presses on the bladder
What are the physiologic changes with the GASTROINTESTINAL system in pregnancy?
- · Hyperptyalism- ↑ saliva because of estrogen
- · Pyrosis / Heartburn- Gas, constipation
- · Decreased gastric motility
- · Nausea and vomiting- Caused by HCG- 1st trimester & higher progesterone levels
What are the physiologic changes with the INTEGUMENTARY system in pregnancy?
- Increased pigmentation- ↑ estrogen, darken nipples
- Striae gravidarum- stretch marks- ↑ adrenal & steroids levels, ↑ estrogen
- Linea negra- Dark line- from ↑ estrogen
- Chloasma- Mask of pregnancy- forehead cheeks- (birth control can also cause??)
What are the physiologic changes with the MUSCULOSKELETAL system in pregnancy?
- Carpal Tunnel Syndrome- ↑ fluid volume and edema
- Diastasis Recti- Sitting to standing- separation of rectus abdomen muscle because uterus enlarges
- Softening of pelvic ligaments and joints as pregnancy progresses because of relaxin
What are the physiologic changes with the ENDOCRINE system in pregnancy?
- Thyroid gland- enlarges and increase metabolic rate
- Parathyroid- Makes you use Ca+ and Vitamin D better
- Pancreas- 1st trimester- ↓ ability to use glucose so baby can use it
- Pituitary gland- Prolactin- prepares body for lactation
What are the physiologic changes with the UTERUS in pregnancy?
- 12th week can palpate the fundus
- Lightening- Dissention of the fetal head into pelvis
- Hegar’s Sign- Softening lower uterine segment (6-8 weeks)
- Braxton Hicks Contractions- False labor, uterus tightening and practicing
What is Hegar's sign?
Softening lower uterine segment (6-8 weeks)
What are the physiologic changes with the CERVIX during pregnancy?
- Goodell’s Sign- Softening of the cervix
- Mucus Plug- Acts as a barrier to from outside pathogens (estrogen), Endocervical canal mucus plug
What is Goodell's sign?
Softening of the cervix, occurs in the 2nd month of pregnancy
What are the physiologic changes with the VAGINA during pregnancy?
- Chadwick’s Sign- 6-8 weeks vaginal walls and cervix change color from pink to blueish/purple color
- Increase in vaginal discharge- White is normal- more acidic
What is Chadwick's sign?
At 6-8 weeks vaginal walls and cervix change color from pink to blueish/purple color
What are the physiologic changes with the BREASTS during pregnancy?
Fullness, tingling, tenderness, darkened areola, prominent blue veins, secretion of colostrum by 16th week
What are the Psychological changes in the first trimester?
- FIRST TRIMESTER (1-12 weeks)
- Announcement- tell other they are pregnant
- Ambivalence- financial worries, etc
What are the Psychological changes in the second trimester?
- SECOND TRIMESTER (13-24 weeks) Differentiation
- Fetal embodiment- accept baby
- Quickening- 16-30 weeks can feel fetal movement
What are the Psychological changes in the 3rd trimester?
- THIRD TRIMESTER (25-40 weeks)- mom become self absorbed? Separation of baby
- Concerned with safe delivery
- Childbirth education
- Nesting- Finding clothes, decorating baby’s room, diapers etc
What is Couvade?
Syndrome which the husband shares cravings, weight gain, etc with his wife
What are the PRESUMPTIVE (subjective) signs of pregnancy?
- “findings reported by the mother that suggest presence of a pregnancy”
- No period, N/V, fatigue, breast changes
What is a molar pregnancy?
The cells multiply but have no heart beat, but gives off the same hormones as if you were pregnant
What are the PROBABLE (objective) signs of pregnancy?
- “findings noted by a healthcare provider that suggest a pregnancy is present”
- Softening of the cervix, Hagar, Chadwick signs, enlarged abdomen, changes in pigmentation
What are the POSITIVE (diagnostic) signs of pregnancy?
- “findings that confirm pregnancy”
- Fetal heart tones, normal fetal heart rate 110-160, fetal movement
- Quickening (mother feeling the baby move)
- HCP can feel uterus at 16-20 weeks just above the pubic bone
- o 5-6 weeks can see sac
- o 8 weeks can see brain and heart
What are the warning signs of pregnancy?
- Bleeding, bright red blood
- Decreased fetal movements
- o HA & visual changes,= increased BP Edema of hands and face
- Visual changes- Fireworks seen, keep blinking eyes, otomata??
What are the signs and symptoms of a placenta abruptio?
- As early separation from uterus in 2-3 trimester
- **Lots of pain & cramping suddenly- emergency C-section
- Seperation of placenta from uterine wall
What are the signs and symptoms of placenta previa?
- Placenta is in the lower uterine wall
- Dx by ultrasound
- ***Painless vaginal bleeding
- Hemmorrhage may happen even if the fundus is contracted firmly
What are the signs and symptoms of INFECTION?
- UTI, abdominal or CP, chills fever, vomiting,
- hyperemesis gravtium- unable to stop vomiting
- ↑ fluid from vagina, constant leaking maybe possible ruptured membranes
What is Nagele's Rule?
- 1st day of last menstrual period, go back 3 months and add 7 days.
- Exp: LMP 11/7/10 Due : 8/14/11
What is gravida?
# of times pregnant
What is parity?
# of infants delivered after 20 weeks (whether they were alive or dead)
What does FPAL stand for?
- F- Full term
- P- preemies
- A- abortions
- L- living children
What is important when looking for past medical history?
- Last Pap smear, STDs, more babies= ↑ risk of hemorrhage
- Chromosomal abnormalities
What initial labs are done when pregnancy is confirmed?
- H&H / WBC
- Blood Type and Cross / RH
- VDRL- syphilis and gonorrhea
- GC - syphilis and gonorrhea
- HBsAg (antibody titer for Rubella / Hep. B)
- MSAFP (16-18 weeks)
- o Maternal serum alpha protein- looks for genetic defects
- Diabetes screen (24-28 weeks)
- o 24-28 weeks
- 1st glucose test – 1hr test- if failed have to take the 3 hour test
- Genetic Screening
- o Sickle cell, Thalassemia- genetic blood disorder of misshaped RBCs
What does TORCH stand for?
- T- Toxoplsmosis
- O- other infections
- R- Rubella
- C- Cytomegalovirus (CMV)
- H- Herpes Simples
What is Toxoplasmosis caused by?
What can it cause?
- Improperly cooked meats or cat feces
- Cause fetal brain damage and high incident of abortions in 1st trimester
What are the "Other" infections?
- Group B streptococcus- pregnancy can aggravate it and Mom will test positive Will do 2-3 rounds of ABX before birth of infant
- Will cause pneumonia in neonate
- If Strep B is unknown- will get 1 round of ABX and infant will go to NICU for observation
What does CYTOMEGALOVIRUS (CMV) cause in the fetus?
Mentally challenged, auditory impairment
What will happen if the Mom has active herpes?
Dr will only deliver vaginally if Mom doesn’t have active herpes, if there is a lesion Mom will have a C-section
How early can you do a ultrasound?
What does it confirm?
- 5 weeks
- confirm pregnancy and gestational age
What is CVS -Chorionic Villus Sampling?
When do you do it?
- Take a sample of the fetal part of the placenta, checks for Down syndrome, sickle cell, muscular dystrophy- (unable to get up at age 2 with all 4 limbs)
- 10-12 weeks gestation
1. What does Amniocentesis measure?
2. How is it done?
3. What is it checking for?
4. When is it usually done?
- 1. L/S ratio- 2:1 (lecithin/sphingomyelin)
- 2. Remove amniotic fluid by needle
- 3. Checking for fetal lung development, especially in large babies
- 4. 14-16 weeks gestation, >30 weeks gestation
1. What is MSAFP - Maternal Serum Alpha Fetal Protein testing for?
2. How many weeks?
- 1. Checking for Neural Tube Defects (NTD) & Down Syndrome
- Blood draw from Mom
- 2. 16-18 weeks gestation
1. Why is PUBS - Percutaneous Umbilical Blood Sampling done?
2. Where is the blood drawn from?
- 1. Transfusion and Fetal blood sampling (looking for abnormalities such as inherited blood disorders, detecting fetal infection, acid-base balance of fetus' with IUGR)
- 2. Blood draw from the umbilical cord
1. When is a BPP - Biophysical Profile usually done and what is it looking for?
2. What are the categories?
3. What is normal? Equivocal? Abnormal?
- 1. Noninvasive assessment of the fetus and its environment using ultrasound and fetal
- Fetal breathing movements
- Gross body movements
- Fetal tone (extension and flexion of arms, legs, and hands)
- Reactive fetal heart rate
- Qualitative amniotic fluid volume
- 3. Normal is 8-10
- Equivocal 6
- Abnormal <4
What does the CST - Contraction Stress Test look for?
o Test to stimulate uterine contractions for the purpose of assessing fetal response, a healthy fetus does not react to contractions, whereas a compromised fetus shows a late decelerations in the fetal heart rate that are indicative of uteroplacental insufficiency.