1st Trimester

Question 1

1st Trimester

Answer 1

0-12 weeks

Question 2

Presumptive signs of pregnancy

Answer 2

• Amenorrhea
• N/V (“morning sickenss”) (most common)
• Unexplained fatigue
• Skin changes
• Sensation of movement in abdomen 16-20wks(quickening)
• Frequent urination (enlarged uterus, increased circulating volume)
• Breast tenderness and changes
• Ptyalism (excess salivation

Question 3

Probable signs of pregnancy

Answer 3

• • pregnacy test (hCG, by blood or urine)
• Softening of cervix at 6-8 wks (Goodell’s sign)
• Bluish coloration of cervix, vagina, and vulva at 6-8 wks (Chadwick’s sign)
• Enlarged abdomen
• Braxton-Hicks
• Passive movement of fetus furing an exam (ballottement)

Question 4

Hegar’s sign

Answer 4

Softening of lower uterine segment

Question 5

Goodell’s sign

Answer 5

Softening of cervix at 6-8 wks

Question 6

Chadwicks sign

Answer 6

Bluish coloration of cervix, vagina, and vulva at 6-8 wks

Question 7

McDonald’s sign

Answer 7

Flexion of body uterus against cervix

Question 8

Braxton Hicks

Answer 8

Irregular, painless uterine contractions that begin in the 2nd trimester

Question 9

Ballottement

Answer 9

Fetal part is displaced by light tap of the examining finger on the cervix and then rebound quickly (occurs about 20-28 weeks)

Question 10

hCG

Answer 10

hormone produced by the chorionic cvilli of placenta

Used to test for pregnancy

Question 11

Radioimmunoassay (RIA)

Answer 11

Type of pregnancy test

Reliable at 1 wk after ovulation

Question 12

Positive signs

Answer 12

• Fetal heart sounds heard by doptone or doppler
• Fetus visible on ultrasound or visualization
• Fetal movements felt by caregiver

Question 13

When can a fetal outline be identified?

Answer 13

After the 24th week

Question 14

Abdominal striae

Answer 14

• Stretch marks

- Breakdown and atrophy of underlying connective tissue

Question 15

What is abdominal striae due to?

Answer 15

The stretching and increased estrogen that causes a rise in adrenal gland activity

Question 16

Fetal ultrasound

Answer 16

• Can be done by the 4th -5th wk of pregnancy if problems
• Noninvasive
• Routinely done at 8-12 wks
• Never done just to determine sex

Question 17

Doppler of FHR

Answer 17

110-160 bpm for 2 mins

Question 18

What are the components of an initial exam?

Answer 18

Medical History
Dates
Pelvic exam
Blood test
Testing for fetal abnormalities
Counseling

Question 19

Medical history during an initial exam

Answer 19

Medical conditions, including allergies
Menstrual cycle, use of contraceptives, past pregnancies, STDs
Prescription or OTC meds
Family history of congential abnormalities or genetic diseases
Sensitive issues, (abortion, past drug use)

Question 20

Naegele’s rule for determining EDB

Answer 20

1st day of LMP minus 3 month plus 7 days and 1 year

Question 21

EDB example using Naegele’s rule if LMP was 4/15/08

Answer 21

1/22/09

Question 22

What does a pelvic exam inlcude?

Answer 22

Normal anatomy throughout
External genitalia- lesions
Vagina- infection, lesions
Cervix- pap, can help to confirm pregnancy
Ovaries- pain, enlargement
Uterus- size

Question 23

How many shapes are there for a bony pelvis?

Answer 23

4:
Gynecoid
Android
Anthropoid
Platypelloid

Question 24

Blood tests during 1st trimester

Answer 24

Blood type, including Rh
Syphilis
MMR
Hep B
HIV
Varicella
Toxoplasmosis

Question 25

Urine tests during 1st trimester

Answer 25

Urinalysis (glucose, protein, signs of infectoin) | Culture and sensitivity- bladder/kidney infection

Question 26

Screening tests during 1st trimester

Answer 26

Chorionic villus sampling Amnocentesis Ultrasound Blood tests- alpha fetoprotein

Question 27

Fetal alpha protein

Answer 27

Protein made by immature liver cells Spills into the amniotic fluid May indicate neural tube defect

Question 28

Why CVS (chorionic villus sampling) or amnio?

Answer 28

- Abnormal results from a prenatal screening test - Chromosomal abnormality in a previous pregnancy - Age 35+ - Family hx of a specific genetic disorder, patient or partner is a known carrier of a genetic disorder - IDs Down syndrom and other disorders (tay-sachs, CF) - Neural tube defect (amnio only) - Lung maturity (late amnio)

Question 29

CVS/Amnio risks

Answer 29

- Miscarriage (CVS has 1/100 risk) - Cramping & Vag bleeding - Rh sensitization (CVS may cause baby's blood cells to enter maternal bloodstream; if Rh-, give Rh immunoglobulin (rhogam) after test) - Infection - Needle stick, leaking fluid (amnio)

Question 30

Counseling for 1st trimester: Lifestyle issues

Answer 30

``` Nutrition Prenatal vitamins Exercise Work environment Tobacco use Substance use (ETOH, drugs, meds) Personal issues ```

Question 31

Counseling for 1st trimester: Body changes

Answer 31

``` Tender breasts Bouts of N/V Unusual fatigue Increased urination Dizziness ```

Question 32

Physiology of changes in pregnancy

Answer 32

``` Increase in candida albicans Mom breathes more deeply Nasal stuffiness Changes in voice Epistaxis Mom's HR increases 10-15 bpm Increase incidence in DVTs Ptyalism Pyrosis Pruritus Waddling gait ```

Question 33

Sycope during pregancy

Answer 33

Blood volume increaes Vascular changes (dilation) allow for the extra blood Pooling in the vascular system