Nurs 4601 BLUEPRINT MATERNITY FINAL:
1. Physiological signs of pregnancy: MAYRA
ANTEPARTUM:
Physiologic Signs of Pregnancy (3questions: 3Physiological, 3Assessment, 2Comprehension, 1Kowledge)
PHYSIOLOGIC SIGNS OF PREGNANCY
● Changes used to dx the pregnancy itself
● The changes are called:
○ Subjective or presumptive change
○ Objective or probable changes
○ Diagnostic or positive changes
SUBJECTIVE (PRESUMPTION) CHANGES
● Are the symptoms the woman experiences and reports
● They cannot be considered proof of pregnancy b/c they can be caused by other
conditions
● Several signs can be dx clues when other signs & symptoms of pregnancy are also
present
AMENORRHEA ● absence of menses
● easiest symptom of pregnancy
● missing more than 1 menstrual period, esp. in a woman
whose cycle is ordinarily regular
● useful diagnostic clue
NAUSEA & VOMITING IN
PREGNANCY (NVP)
● occurs freq. during the FIRST trimester
● may be mild or may cause considerable distress
● morning sickness b/c it occurs in the early part of the
day
● experience NVP = more favorable pregnancy outcome
than those who do not
EXCESSIVE FATIGUE ● may be noted within a few weeks after the first missed
menstrual period and may persist throughout the first
trimester
URINARY FREQUENCY ● experienced during the first trimester as the enlarging
uterus presses on the bladder
CHANGES IN THE BREASTS ● noted in early pregnancy
● changes include
○ tenderness
○ tingling sensations
○ increased pigmentation of the areola & nipple
○ changes in Montgomery’s gland
○ veins more visible & form a bluish pattern
beneath the skin
QUICKENING ● mother’s perception of fetal movement
○ occurs about 18 – 20 weeks
○ after the last menstrual period in a women
pregnant for the first time
○ may occur as early as 16 weeks in a woman
who has been pregnant before
● Fluttering sensation in the abdomen that gradually
increases in intensity and frequency
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OBJECTIVE (PROBABLE) CHANGES
● Examiner can perceive the objective changes that occur in pregnancy
● DO NOT confirm pregnancy b/c they can have other causes
CHANGES IN THE PELVIC
ORGANS
● INCREASED VASCULAR CONGESTION
○ Only physical changes detectable during the
first 3 months of pregnancy
○ Changes noted on pelvic exam
● GOODELL’S SIGN
○ softening of the cervix
● CHADWICK’S SIGN
○ bluish, purple, or deep-red discoloration of
the mucous membranes of the cervix, vagina,
and vulva
● HEGAR’S SIGN
○ softening of the isthmus of the uterus, the
○ area b/w the cervix & the body of the uterus
● MCDONALD’S SIGN
○ Ease in flexing of the body of the uterus
against the cervix
● General enlargement & softening of the body of the uterus can be noted after the EIGHT
WEEK OF PREGNANCY
● Fundus of the uterus is palpable
○ Just above the symphysis pubis at about 10 – 12 weeks’ gestation
○ & at level of umbilicus at 20 – 22 weeks’ gestation
ENLARGEMENT OF THE
ABDOMEN
● Childbearing years is usually regarded as evidence of
pregnancy, esp. if it is continuous & accompanied by
AMENORRHEA
BRAXTON HICKS
CONTRACTIONS
● Palpated most commonly after the 28th week
○ UNCOMFORTABLE when woman
approaches the end of pregnancy
● Often called FALSE LABOR
UTERINE SOUFFLE ● Heard when the examiner auscultates the abdomen
over the uterus
● Soft, blowing sound that occurs at the same rate as
the maternal pulse
● Caused by increased uterine blood flow & blood
pulsating through the umbilical cord
● Funic souffle = same rate FHR
CHANGES IN PIGMENATION
OF THE SKIN
● Common in pregnancy
● Nipples & areolae may darken
● Linea nigra may develop
● Facial melisma (chloasma) may become noticeable
● Striae may appear
FETAL OUTLINE ● Palpation in many pregnancy women after
○ 24 weeks’ gestation
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● Ballottment
○ Passive fetal movement elicited when the
examiner inserts two gloved fingers into the
vagina & pushes against the cervix
○ Action pushes the fetal body up, &, as it falls
back, the examiner feels a rebound
PREGNANCY TESTS ● Detect the presence of hCG in the maternal blood or
urine
● Not considered a positive sign of pregnancy b/c other
condition can elevate hCG levels
Clinical Pregnancy Tests
● Assay techniques available to detect hCG in either blood or urine during early pregnancy
● Most providers use urine screening tests b/c
○ results are immediate
○ minimal cost
○ tests are reasonably accurate
○ no invasive procedure (blood draw) is required
● most pregnancy test are based on approach called enzyme-linked immunosorbent assay (ELISA)
○ ELISA uses a substance that results in a color change after binding
○ Assay can be done on blood or urine, is sensitive, quick, & can detect hCG levels as early as 7 to 9 days
after ovulation and conception, which is 5 days before the first missed period
● Fluoroimmunoassay (FIA) another approach to testing
○ uses an antibody tagged w/ a fluorescent label to detect serum hCG
○ takes about 2 to 3 hours to perform
○ extremely sensitive
○ used primarily to identify & follow hCG concentration
Over-the -counter Pregnancy Tests
● reasonable cost
● ELISA tests, performed on urine, detect even low level of hCG
● Test instruction followed carefully
● Negative results = repeat in 1 week if she has not started her period
DIAGNOSTIC (POSITIVE) CHANGE
● Completely objective
● Cannot be confused w/ a pathologic state
● Offer conclusive proof of pregnancy
FETAL HEARTBEAT ● electronic Doppler device as early as
weeks 10 -12 of pregnancy
FETAL MOVEMENT ● actively palpable by a trained examiner
after about the 20th week of pregnancy
VISUALIZATION OF THE FETUS BY
ULTRASOUND EXAMINATION
● Confirms pregnancy
● Gestational sac observed by 4 – 5
weeks’ gestation (2 to 3 weeks after
conception)
● 8 weeks’ gestation à see fetal parts &
movement
● Transvaginal ultrasound has been
used to detect a gestational sac as
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early as 10 days after implantation
2. Biophysical profile BPP: MAYRA 2 questions: 2Physiological, 1Assessment, 1Implementation,
2Comprehensive
Biophysical Profile (BPP)- Assessment of Five Variables
● Comprehensive assessment of five variables after 28 weeks
1) Fetal breathing movement
2) Fetal movement of body or limbs
3) Fetal tone (extension or flexion of extremities)
4) Amniotic fluid volume
5) Reactive fetal heart rate (FHR) with activity (reactive nonstress test [NST])
*Four variables by ultrasound scanning and fifth by NST.
Purpose of the BPP
● Helps to either identify the compromised fetus or confirm the healthy fetus
● Provides an assessment of placental functioning
Scoring Criteria
● Score of 2 assigned to each normal finding
● Score of 0 assigned to each abnormal finding
● Maximum score of 10
● Scores of 8 (with normal amniotic fluid) and 10 considered normal
❏ Reflect least chance of being associated with compromised fetus unless decreased amount of amniotic
fluid noted
Indications for BPP – Risk factors related to placental insufficiency or Fetal Compromise
● Intrauterine growth restriction (IUGR)
● Maternal diabetes mellitus
● Maternal heart disease
● Maternal chronic hypertension
● Maternal preeclampsia or eclampsia
● Maternal sickle cell anemia
● Suspected fetal postmaturity (more than 42 weeks' gestation)
● History of previous stillbirths
● Rh sensitization
● Abnormal estriol excretion
● Hyperthyroidism
● Renal disease
● Nonreactive NST
3. Danger signs in pregnancy: carmen
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Version | 2021 |
Category | Exam (elaborations) |
Authors | expert |
Pages | 136 |
Language | English |
Comments | 0 |
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