OBGYN Exam 1
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What is a blue-purple discoloration of the cervix (mucus membranes) called
What is softening of the cervix called
What are purplish stretch marks that slowly turn silver after childbirth
What is an anti-body rich, yellow secretion, may be expressed manually by the 12th week and may leak from the breasts during the last trimester
What is an ease in flexing the body of the uterus against the cervix
What is the position of the fundus at 10-12 weeks? at 20-22 weeks?
- 10-12: palpable just above the symphisis pubis
- 20-22 weeks: at the level of the umbilicus
What refers to the midline of the abdomen from the pubic area to the umbilicus and above
What is increased pigmentation of linea alba called when the area begins to darken
What is irregular pigmentation of the cheeks, forehead, and nose accompanied by sun exposure (mask of pregnancy)
What is gravida
any pregnancy regardless of duration, including the present
What is para
birth after 20 weeks regardless of whether infant lived or died
When is fundal height a good indicator of uterine size? How big should it be in correlation wth weeks gestation?
- 22-34 weeks
- (if 34 weeks, then 34 cm etc)
What things can interfere with accuracy of fundal height?
- maternal position
- maternal height
- 3rd trimester (fetal weight)
- obese women
- women with uterine fibroids
- women with hydroamnios
What causes the uterus to increase its capacity from 10 mL to 5.1 L?
- Increase in cells (hypertrophy) in response to estrogen
- Distention of the growing fetus
How does the cervix keep bacteria from entering the uterus
Secretes mucus that forms a plug at the opening of the endocervical canal
What 3 reproductive organs does estrogen influence? How?
- Cervix: mucus plug
- Vagina: thicken mucus/relax connective tissue
- Breasts: enlarge and increase number
What is the increase of cardiac output in a pregnant woman? pulse?
What causes a decrease in blood pressure throughout the first and second trimester of pregnancy
Pulmonary and Peripheral vascular resistance decreases by 40-50%
How can postural hypertension develop during the third semester of pregnancy
Uterus presses on pelvic and femoral vessels limiting blood return to the heart
What can result in decreased blood flow to the right atrium and a decrease in blood pressure? How does this happen?
- Vena Cava Syndrome
- gravid uterus compresses vena cava
How can Vena cava syndrome be prevented/treated
lay the woman on her left side with a pillow under her right hip
A pregnant woman presents to labor and delivery complaining of dizziness. You note that she seems pale and is diaphoretic. What is this an indication of?
Vena cava syndrome
What is the increase of blood volume for pregnant woman? RBC? Plasma?
Why is there a decrease in HCT by 7% leading to physiologic anemia?
Due to increased blood volume, RBC, and plasma volume, the blood becomes diluted
What does the respiratory volume increase to? what is the reason for this increase?
- Decreased airway resistance in response to progesterone
Why does the intrathoracic volume remain unchanged even though the uterus presses up to the diaphragm
The rib cage flares and the chest circumference increases
What causes the waddling gait in pregnancy
relaxation of pelvic joint
What can cause diastasis recti separation of the abdominal muscles?
What causes low back pain in pregnancy
physiological lordosis as a result of the weight of gravid uterus
What causes N/V in the first trimester
What causes bloating, constipation, and gastic reflux in pregnancy
Increased progesterone levels relax smooth muscles decreasing peristalsis
What worsens GI symptoms in pregnancy
pressure of gravid uterus on intestines
What can cause hemorrhoids in pregnancy
constipation and increased pressure on blood vessels in the rectum
What causes increased urinary frequency in the first trimester
gravid uterus presses on the bladder
When is urinary urgency relieved in pregnancy and how is it relieved? When will it return?
- Second trimester
- The uterus moves into the abdominal cavity
- Third trimester
What causes glycosuria?
GFR increases by 50% limiting the kidneys from absorbing all of the glucose
What causes increased levels of pigmentation in the areola, nipples, vulva, etc...
What is an increase in pigmentation on the forehead and around the yes (aggravated by sun exposure, common in women of color)
What is darkly pigmented line that extends from umbilicus to pubic area
What is reddish streaks on trunk and thighs? What color do they change to after delivery
- Striae gravidarum
- shiny gray-white
What causes striae gravidarum
Stretching of connective tissue due to increased adrenal steroid levels
What is the recommended total weight gain for normal weight before pregnancy? First trimester? Subsequent trimesters?
- 25-35 lbs
- 3-5 lbs
- 1 lb/week
What causes water retention in pregnancy
- increased sex hormones
- decreased serum protein
What hormone is secreted by trophoblast early in pregnancy?
What two hormones does hCG stimulate
estrogen and progesterone
What is another word for chorionic somatomammotropin
Human placenta lectogen (hPL)
What produces estrogen and progesterone for the first 7 weeks of pregnancy and later by the placenta
What stimulates uterine development to support fetal growth and stimulates the ductal system of the breast for lactation
Name 4 functions of progesterone
- maintain endometrium
- decrease uterine contractility
- stimulate breast achini and lobules
- relax smooth muscle causing heartburn
What is Relaxin primarily made by
What 3 things does relaxin do
- decrease uterine contractility
- helps soften cervix
- long term effects on collagen
What lipids found in the female reproductive system contribute to the decrease in placental vascular system and probably contribute to onset of labor
How many extra calories does a pregnant woman need?
Describe the distribution of weight gain in pregnancy
- fetus/placenta/amniotic fluid: 11 lbs
- uterus: 2 lbs
- Increased blood volume: 4 lbs
- Breast tissue: 3 lbs
- Maternal stores: 5-10 lbs
What is the primary nursing diagnosis related to psychosocial changes in pregnancy
Potential alteration of family processes
What does TPAL stand for regarding para
- T: # born >37 weeks
- P: # born 20-37 weeks
- A: # abortions (spontaneous or therapeutic) before 20 weeks
- L: # children living
Name 6 presumptive signs of pregnancy (subjective)
- urinary frequency
- breast changes
- quickening (16-20 weeks)
Name 7 probable signs of pregnancy (objective)
- Hegar's sign
- McDonald's sign
- Chadwick's sign
- Goodells sign
- Abd enlargment
- skin pigmentation changes
- fetal outline
What is softening of isthmus of uterus called
Name 3 diagnostic (definitive) signs of pregnancy
- Fetal heart beat
- Fetal movement felt by provider
- Visualization of ultrasound
How do you calculate estimated due date using Nagele's rule
Subtract 3 months from LMP and add 7 days
What method of estimating due date uses uterine size to indicate gestational age by measuring in CM the distance from the symphysis pubis to top of uterine fundus
When can a doppler advice be used for fetal heart tone/minute
What should the fetal heart rate normally be
How often should a woman be seen for prenatal visits?
- 1/month until 28 weeks
- 2/month 28-36 weeks
- weekly until delivery
What does a gush of fluid from the vagina indicate
rupture of membranes
What can vaginal bleeding indicate in pregnancy
abruption or previa or bloody show
What can abdominal pain indicate in pregnancy
preterm labor or abruption
When is alpha feto-protein level checked to screen for neural tube defect
When does mom do blood glucose challenge test
What does the US rank in infant mortality
What is the number of deaths per 1000 live births in the first 28 days of life
What is the number of deaths per 1000 live births in the first year of life
What is death from beginning of pregnancy through 6 weeks after delivery
What is poverty level for a family of 4
What does FMLA allow for pregnant women for unpaid leave? What are the restrictions
- 3 months
- <50 employees at the job
- Worked less than 1 year
- Work <25 hrs/week
What are fatty acids from fish and red meat important for
- placental growth
- fetal brain development
- fetal visual function
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