NR602
Presumptive signs of pregnancy - Answer-Subjective signs. Amenorrhea, nausea, vomiting, increased
urinary frequency, excessive fatigue, breast tenderness, quickening at 18-20 weeks.
Probable signs of pregnancy - Answer-Objective Signs. Goodell sign (softening of cervix), Chadwick sign
(cervix is blue/purple), Hegar's sign (softening of lower uterine segment), uterine enlargement, Braxton
Hicks contractions (may be plapated by 28 weeks), uterine souffle (soft blowing sound due to blood
pulsating through the placenta), integumentary pigment changes, ballottement, fetal outline definable,
positive pregnancy test (could be hydatidiform mole, choriocarcinoma, increased pituitary
gonadotropins at menopause).
Positive signs of pregnancy - Answer-Diagnostic. Fetal heart rate auscultated by fetoscope at 17-20
weeks or by Doppler at 10-12 weeks, Palpable fetal movement after 20 weeks, visualization of fetus with
cardiac activity by ultrasound (fetal parts visible by 8 weeks).
Pregnancy and fundal height measurement - Answer-As pregnancy progresses, the fundus rises out of
the pelvis. At 12 weeks gestation, the fundus is located at the level of the symphysis pubis and the
umbilicus. By 20 weeks gestation, the fundus is at the same height as the umbilicus. Until term, the
fundus enlarges 1 cm per week. As the time for birth approaches, the fundal height drops slightly. This
process is called lighting and occurs mostly for primigravida and may not occur for woman who are
multigravida until she goes into labor.
Naegele's rule - Answer-The EDB for women with 28 day cycles - Nagele's rule - Add 7 days to LMP then
subtract 3 months.
Example: 4/23 LMP of April 23 + 7 days = 4/30 (April 30th) - 3 months = January 30th (following year)
Hematological changes during pregnancy - Answer-During pregnancy, the heart is displaced upward and
to the with withing the chest cavity by the gravid uterus's pressure on the diaphragm. As pregnancy
progresses, the risk for inferior vena cava and aortic compression leading to supine hypotension
increases when the woman lies in a supine position. Advice pregnant women to lie left lateral position.
,Cardiac output in pregnancy increases by 30-50%. Peaks in early third trimester and maintained until
birth. Stroke volume is also increased during pregnancy by 20-30% which allows for the 30% increase in
oxygen consumption observed during pregnancy. Heart rate and heart sounds changes. Volume of the
first heart sound may be increased with splitting. 3rd heart sound may be detected. Systolic murmurs
may be detected. Increase of 15-20 beats/min by 32 weeks gestation. BP decreases by 5-15 mm Hg due
to peripheral vascular resistance. 1st and 3rd trimester should be pre-pregnancy values. Blood volume
increases by 30-50% and peaks at 30-34 weeks gestation. 75% of the increase of blood volume is
plasma. Blood volume changes results in anemia due to the hemodilution. Clotting factors increase as
well creating a risk for clotting during pregnancy.
Indications and contraindications for prescribing combined estrogen birth control - Answer-Combined
Estrogen - Take everyday, has hormone free intervals of 7 days,
Indications - Safe for healthy women. Studies show a decrease in the possibility of endometrial or
cervical cancer not found with the mini pill or POP.
Contraindications - direct effects of the hormonal ingredient, as in breast cancer, or thromboembolism.
Indications and contraindications for prescribing progesterone-only birth control - Answer-
Progesterone-only - Mini pill - must take every day at the same time and there are no hormone free
intervals. These pills only thicken the cervical mucus to prevent pregnancy. Make the mucus thick for 22
hours so it needs to be taken constantly to avoid the mucus to return to regular consistency.
Indications - POPs are a safe method for many women who cannot take estrogen for medical reasons.
POPs are preferable to COCs for lactating women because they do not cause adverse effects on the
volume or quality of breastmilk.
Contraindications - almost none.
menarche - Answer-The initiation of menstruation, called menarche, usually happens between the ages
of 12 and 15
Influenza (flu)a - Answer-Women who are pregnant are at increased risk for flu-related complications.
Any gestation when the injection is available
, Tetanus, diphtheria, pertussis (Tdap) - Answer-After maternal vaccination, antibodies cross the placenta
and decrease the risk of pertussis infection in the newborn.
Third trimester (ideally 27-36 weeks' gestation)
Hepatitis B - Answer-If the woman is at risk for acquiring HBV, she should be vaccinated. Indications
include risk of occupational exposure to blood, treatment for a sexually transmitted infection, more than
1 sex partner in the past 6 months, recent intravenous drug use, and HBsAg-positive sex partner. 3
injections beginning at any point in gestation
Measles, mumps, rubella - Answer-This live virus vaccine has a (theoretical) risk to the fetus.
Varicella - Answer-This live virus vaccine has a (theoretical) risk to the fetus.
Sperm can live for up to 5 days in the female reproductive tract, and pregnancy can occur with
intercourse 5 days prior to ovulation. The highest risk of pregnancy is... - Answer-in the 48 hours
immediately preceding ovulation
Tier 1 methods of contraception and efficacy - Answer-Most effective - less than 1 per 100 pregnancies -
Vasectomy, implant, tubal occlusion, and IUD. After procedure, little or nothing to do or remember
Vasectomy: Use another method for first 3 months.
Tier 2 methods of contraception and efficacy - Answer-4-7 pregnancies per 100 woman - Injectable: Get
repeat injections on time Pills: Take a pill each day Patch, ring: Keep in place, change on time.
Tier 3 methods of contraception and efficacy - Answer-Least effective - Condoms, sponge, withdrawal,
spermicides, diaphragm: Use correctly every time you have sex Fertility awareness-based methods:
Abstain or use condoms on fertile days. Newer methods (Standard Days, Natural Cycles, and
Symptothermal may be easier to use and consequently more effective).
most common cause of amenorrhea - Answer-Ovarian function abnormalities are the most common
cause of amenorrhea, and estrogen production is the most reliable measure of ovarian function
Presumptive signs of pregnancy - Answer-Subjective signs. Amenorrhea, nausea, vomiting, increased
urinary frequency, excessive fatigue, breast tenderness, quickening at 18-20 weeks.
Probable signs of pregnancy - Answer-Objective Signs. Goodell sign (softening of cervix), Chadwick sign
(cervix is blue/purple), Hegar's sign (softening of lower uterine segment), uterine enlargement, Braxton
Hicks contractions (may be plapated by 28 weeks), uterine souffle (soft blowing sound due to blood
pulsating through the placenta), integumentary pigment changes, ballottement, fetal outline definable,
positive pregnancy test (could be hydatidiform mole, choriocarcinoma, increased pituitary
gonadotropins at menopause).
Positive signs of pregnancy - Answer-Diagnostic. Fetal heart rate auscultated by fetoscope at 17-20
weeks or by Doppler at 10-12 weeks, Palpable fetal movement after 20 weeks, visualization of fetus with
cardiac activity by ultrasound (fetal parts visible by 8 weeks).
Pregnancy and fundal height measurement - Answer-As pregnancy progresses, the fundus rises out of
the pelvis. At 12 weeks gestation, the fundus is located at the level of the symphysis pubis and the
umbilicus. By 20 weeks gestation, the fundus is at the same height as the umbilicus. Until term, the
fundus enlarges 1 cm per week. As the time for birth approaches, the fundal height drops slightly. This
process is called lighting and occurs mostly for primigravida and may not occur for woman who are
multigravida until she goes into labor.
Naegele's rule - Answer-The EDB for women with 28 day cycles - Nagele's rule - Add 7 days to LMP then
subtract 3 months.
Example: 4/23 LMP of April 23 + 7 days = 4/30 (April 30th) - 3 months = January 30th (following year)
Hematological changes during pregnancy - Answer-During pregnancy, the heart is displaced upward and
to the with withing the chest cavity by the gravid uterus's pressure on the diaphragm. As pregnancy
progresses, the risk for inferior vena cava and aortic compression leading to supine hypotension
increases when the woman lies in a supine position. Advice pregnant women to lie left lateral position.
,Cardiac output in pregnancy increases by 30-50%. Peaks in early third trimester and maintained until
birth. Stroke volume is also increased during pregnancy by 20-30% which allows for the 30% increase in
oxygen consumption observed during pregnancy. Heart rate and heart sounds changes. Volume of the
first heart sound may be increased with splitting. 3rd heart sound may be detected. Systolic murmurs
may be detected. Increase of 15-20 beats/min by 32 weeks gestation. BP decreases by 5-15 mm Hg due
to peripheral vascular resistance. 1st and 3rd trimester should be pre-pregnancy values. Blood volume
increases by 30-50% and peaks at 30-34 weeks gestation. 75% of the increase of blood volume is
plasma. Blood volume changes results in anemia due to the hemodilution. Clotting factors increase as
well creating a risk for clotting during pregnancy.
Indications and contraindications for prescribing combined estrogen birth control - Answer-Combined
Estrogen - Take everyday, has hormone free intervals of 7 days,
Indications - Safe for healthy women. Studies show a decrease in the possibility of endometrial or
cervical cancer not found with the mini pill or POP.
Contraindications - direct effects of the hormonal ingredient, as in breast cancer, or thromboembolism.
Indications and contraindications for prescribing progesterone-only birth control - Answer-
Progesterone-only - Mini pill - must take every day at the same time and there are no hormone free
intervals. These pills only thicken the cervical mucus to prevent pregnancy. Make the mucus thick for 22
hours so it needs to be taken constantly to avoid the mucus to return to regular consistency.
Indications - POPs are a safe method for many women who cannot take estrogen for medical reasons.
POPs are preferable to COCs for lactating women because they do not cause adverse effects on the
volume or quality of breastmilk.
Contraindications - almost none.
menarche - Answer-The initiation of menstruation, called menarche, usually happens between the ages
of 12 and 15
Influenza (flu)a - Answer-Women who are pregnant are at increased risk for flu-related complications.
Any gestation when the injection is available
, Tetanus, diphtheria, pertussis (Tdap) - Answer-After maternal vaccination, antibodies cross the placenta
and decrease the risk of pertussis infection in the newborn.
Third trimester (ideally 27-36 weeks' gestation)
Hepatitis B - Answer-If the woman is at risk for acquiring HBV, she should be vaccinated. Indications
include risk of occupational exposure to blood, treatment for a sexually transmitted infection, more than
1 sex partner in the past 6 months, recent intravenous drug use, and HBsAg-positive sex partner. 3
injections beginning at any point in gestation
Measles, mumps, rubella - Answer-This live virus vaccine has a (theoretical) risk to the fetus.
Varicella - Answer-This live virus vaccine has a (theoretical) risk to the fetus.
Sperm can live for up to 5 days in the female reproductive tract, and pregnancy can occur with
intercourse 5 days prior to ovulation. The highest risk of pregnancy is... - Answer-in the 48 hours
immediately preceding ovulation
Tier 1 methods of contraception and efficacy - Answer-Most effective - less than 1 per 100 pregnancies -
Vasectomy, implant, tubal occlusion, and IUD. After procedure, little or nothing to do or remember
Vasectomy: Use another method for first 3 months.
Tier 2 methods of contraception and efficacy - Answer-4-7 pregnancies per 100 woman - Injectable: Get
repeat injections on time Pills: Take a pill each day Patch, ring: Keep in place, change on time.
Tier 3 methods of contraception and efficacy - Answer-Least effective - Condoms, sponge, withdrawal,
spermicides, diaphragm: Use correctly every time you have sex Fertility awareness-based methods:
Abstain or use condoms on fertile days. Newer methods (Standard Days, Natural Cycles, and
Symptothermal may be easier to use and consequently more effective).
most common cause of amenorrhea - Answer-Ovarian function abnormalities are the most common
cause of amenorrhea, and estrogen production is the most reliable measure of ovarian function
