OB Final Exam Study Guide

Signs of Pregnancy: Presumptive, Probable, & Positive  Presumptive o Things that could be due to pregnancy but could also be explained by something else  Fatigue, breast tenderness, N/V, Amenorrhea, Urinary Frequency, hyperpigmentation of the skin, quickening, uterine enlargement, and breast enlargement.  Probable o You’re probably pregnant, but we don’t know for sure  Braxton hicks contractions, Positive pregnancy test, abdominal enlargement, ballottement (examiner pushes on cervix and feels rebound from fetus), Goodell’s sign, Chadwick’s sign, Hegar’s sign  Positive o You are definitely pregnant!  Seeing a fetus or embryo on an ultrasound  Fetal movement felt by a clinician  Auscultating fetal heart tones w/ doppler GTPAL classification  G – How many pregnancies  T – How many pregnancies to term >38 weeks  P – How many pregnancies were preterm <38 weeks  A – How many abortions <20 weeks  L – How many living children Naegle’s Rule  First Day of LMP – 3 months + 7 Days = Due date Nutrition in Pregnancy  INCREASE o Calories – 2,500 calories/day o Protein – 80g/day o Iron – 27g/day o Folic acid – 800mcg/day Weight gain in pregnancy  Underweight women should gain 28-40 pounds o 5 lbs in the 1st trimester o Then 1.2 lbs per week  Normal weight women should gain 25-35 pounds o 3.5-5 lbs in the first trimester o Then ~1lb per week  Overweight women should gain 15-25 pounds o 2 lbs in first trimester o Then 2/3 lb per week  Obese women should gain no more than 15 pounds Exercise in pregnancy  Exercise during pregnancy is encouraged but the intensity and duration should be modified  Contraindicated in preterm labor, poor weight gain, anemia, face and hand edema, pain, hypertension, threatened abortion, dizziness, SOB, multiple gestation, decreased fetal activity, cardiac disease and palpitations  150 minutes of moderate intensity exercise per week  Helps return the woman’s body to normal after pregnancy  Low-impact aerobic exercises with stretching before and after  Never exercise to the point of exhaustion Danger/warning signs of pregnancy  First trimester o Spotting or bleeding, painful urination, severe persistent vomiting, lower abdominal pain with dizziness and shoulder pain.  Second Trimester o Regular uterine contractions, pain in calf, often increased with foot flexion, sudden gush or leakage of fluid from the vagina, and absence of fetal movement for more than 12 hours  Third Trimester o Sudden weight gain, periorbital or facial edema, severe abdominal pain, headache w/ visual changes, decrease in fetal daily movement for more than 24 hours. Common discomforts of pregnancy  First Trimester o Urinary frequency or incontinence  Decrease fluids 2-3 hrs before bed, limit intake of caffeine, Kegel exercises, empty bladder with first full sensation o Fatigue  Get a full night’s sleep, healthy well-balanced diet, nap in the early afternoon, rest when you feel tired. o N/V  Avoid an empty stomach, eat dry crackers before getting out of bed, eat several small meals throughout the day, avoid brushing teeth immediately after eating, Acupressure wristbands, drink fluids between meals, avoid greasy, fried foods, or foods with a strong odor. o Breast tenderness  Wear a larger bra with good support even while she’s sleeping o Constipation  Eat fresh or dried fruit with the skins on, whole grain cereal and breads, increase physical activity, pelvic floor exercises, stretching exercises, and yoga daily, meals at regular intervals, defecate at a certain time each day, use a Squatty Potty, increase water intake, decrease refined carbs, warm fluids in the morning, avoid large amounts of cheese. o Nasal stuffiness, bleeding gums, and epistaxis  Increase fluids, use a humidifier in room at night, advise her to blow her nose gently, one nostril at a time, avoid nasal decongestants and sprays. If her nosebleed advise her to loosen clothing around her neck, tilt her head forward, pinch nostrils for 10-15 minutes, and apply an ice pack to her nose. Advise her to practice good oral hygiene, soft toothbrush and flossing daily, warm saline mouth washes. o Cravings  Watch out for Pica o Leukorrhea  Keep perineal area clean and dry, wash with mild soap during shower, avoid pantyhose or tight nylon clothes, encourage cotton underwear and the use of a nightgown, avoid douching and tampon use.  Second Trimester o Backache  Avoid standing or sitting for long periods, apply heating pad, put pillows behind back when sitting, use proper body mechanics when lifting, avoid excessive bending, lifting or walking without rest, wear supportive shoes, avoid heels, maintain good posture. o Leg Cramps  Elevate the legs above heart level, straighten both legs and flex feet toward your body, taking additional calcium supplements o Varicosities of the leg and vulva  Walking daily, elevate legs, avoid standing in one positions too long, avoid constrictive knee-high stocking and socks, don’t cross legs when sitting, wear support stockings for better circulation. o Hemorrhoids