Study Guide: Maternity Test 1
ANTEPARTUM STAGE - Occurs From first day of missed period to labor
Signs of pregnancy: Presumptive, Probable, Positive. - (basically levels of surness)
Presumptive: Patient PRESUMES they are pregnant for any of the following reasons.
- Experiencing; 0 periods, N/V, Fatigue, ↑ Urination, Breast Change (tenderness or
darkness) , Quickening; first flutter of movements (between 14 - 18 weeks).
- Does not guarantee that pt is pregnant, this the moms interpretation
Probable: These are signs a PROVIDER notices the following…
- The provider may note; Enlarged abdomen, + pregnancy test
- Hegar’s sign - softening of the Uterus in cervix/the whole lower segment of the uterus
- Chawhick’s sign - Blushing/Blue/purple coloring of vaginal mucosa
- Goodell’s sign - Softening of just the cervical lip (L in lip and L in Goodell to distinguish
from Hegar’s)
- BUT these are still not concrete even though the MD notes these signs.
Positive: These are the ONLY things that can POSITIVELY PROVE pregnancy!
- Provider will see fetal movement
- Palpate fetus after 20 weeks using Leopold's maneuver
- Use fetal sonography to see heartbeat @ 10-12 weeks
Naegel’s Rule - figures out E.D.D
- Take first day of last pd., count back 3 months, add 7 days, add year to reflect birth.
Nutrition - Tied to BMI
- Must teach pt. From preconception to pregnancy, incorporating diet and physical activity & get
baseline @ first appointment.
- Teaching points:
- Appropriate portion size, 300 additional calories, rinse raw fruits/veggies, 8-10 glasses
of water per day
- Prenatal vitamins- importance of folic acid (4mg-.6mg daily), Calcium, magnesium,
Vitamin D, iron (absorbed well with citrus/vitamin C)
- Special diets with or risk for HTN (DASH- limit trans/saturated fat & excessive sugar)
- What to eat?
- Foods from all food groups: Fresh fruits, veggies, lean protein, low fat or non fat dairy
foods, whole grains, small amounts of healthy fats, iron rich foods (apricots, beans,
legumes, leafy greens)
- What to Avoid?
- Caffeine (<200mg daily), fish w/ high levels of methylmercury (king
mackerel/shark/swordfish/tilefish), unpasteurized juices/dairy products, live cultured
foods, raw sprouts, soft cheese (brie/feta), Smoked seafood, unheated deli meats or
hot dogs,
, - Make sure ALL meat/fish/eggs/seafood are FULLY cooked
- Pt. should gain weight as follows
- 1st trimester = 1-5lbs
- 2nd & 3rd = .5lb-1lb per week
- Weight gain related to BMI
- Underweight pt categorized: BMI less than 18.5; expected to gain 28-40lbs
- Normal weight pt categorized: BMI of 18.5-24.9; expected to gain 25-35lbs
- Overweight pt categorized: BMI 25.0-29.9 ; expected to gain 15-25lbs
- Obese pt categorized: BMI greater than 30.0; expected to gain 11-20lbs
Exercise
- Pt. basically should keep prepregnancy routine unless MD says otherwise
- No reg routine? MD recommends walk 3x a week for 20 mins
- BUT of course pt needs to avoid potential abdominal trauma/falls + overheating, or supine
positioning
- STOP exercise if experiencing any abnormals;
- Vag bleeding, cramping, leakage of fluid, decreased fetal movement, dizziness, HA,
chest pain, calf pain, dyspnea
- EXTREMELY SERIOUS WARNING SIGNS: SEE MD
- Dysuria, alt blurred vision, flashes of light, severe epigastric pain elevated temp,
persistent vomiting THIS PERSON IS PHYSICALLY ILL
Fetal Development
- What forms when? If there is a malformation with one system odds are whatever develops at
the same time will also have issues!
- 4 weeks: HEART BEAT, brain stem formed from anterior neural tube, limb bulbs, GI system starts
to form (just tubes, bulbs and beats at this point - most people don’t even know they’re preg
yet so not much is going on)
- 6 weeks: 12mm, primitive skeletal shape, heart chambers, respiratory system begins, ear
formation, BY 8 WEEKS ALL BODY ORGANS ARE FORMED (way more going on ppl are usually
figuring out they’re preg)
- 12 weeks: 8cm, ossification of skeleton begins, liver produces red cells, palate in mouth formed,
skin is pink, thyroid hormone presents, insulin present in pancreas
- Think: 12 weeks, 12 is a preteen when all the hormones start (insulin, thyroid, +mouth
formation cause they get more sassy)
- By 8-12 weeks HR can be seen via ultrasound
- 16 weeks: 13.5 cm, meconium begins to collect in the intestines, kidneys assume shape, hair on
scalp Harmony test can be done by 13 weeks, sex is seen, starts to look like a baby
- 20 weeks: 19 cm; myelination of spinal cord begins, suck/swallow, vernix protects body,
surfactant production brain appears mature (FEELS MOVEMENT, baby has all these new abilities
makes sense b/c it's at age of viability)
- 40 weeks: 40 cm, adequate surfactant, vernix skin folds, lanugo on shoulders, earlobes formed,
sex aparent , smooth polished skin (baby is done cooking)
, Prenatal Labs - ID dangers/complications to mom and baby w goal of early intervention!
- CBC - Infection, blood disease
- Serology (RPR/VDRL) - Disease testing / STDS
- HIV - Mandatory in 1st and 3rd trimester
- Blood typing, RH, antibody screen. *If RH- check for presence of anti RH antibodies if the baby is
+, which we assume if we let her get sensitized NEXT pregnancy will be attacked
- Rubella TITER, mom Should be immune. If not MMR is a live vaccine WILL NOT GIVE to preg
mom. After birth she can get it but CAN’T get preg again for ONE MONTH
- Hepatitis B
- Hemoglobin electrophoresis; Things like sickle cell
- TB; WANT Below 10 or NEG … greater = exposed. Tests by PPD or t-spot (which is used more)
- Prenatal Genetic testing
- Urinalysis/ Culture: looking for INFECTION like UTI b/c it can cause preterm labor. Watching for
PROTEIN for PREECLAMPSIA and GLUCOSE for DIABETES
- Vaginal exam; for Infections, cancers or any abnormals
- Gonorrhea/chlamydia culture; checked in 1st and 3rd trimester
- Drug screening; Only done with consent, we are mandatory reporters so child protective
services can be called with suspicion, may involve case worker first. First stool can be drug
tested - is it safe for baby to go home with mom?
Inheritance pattern
- Autosomal Dominant; STRONG, only need one altered gene to give baby 50/50 chance of having
alteration (ex. Marfan, Dwarfism)
- Autosomal Recessive; Weak, Both parents need to have weak gene or trait
- 25% to express gene, 25% wont be an expresser or carrier, 50/50 baby carries (Ex. sickle
cell; test mom/dad)
- Sex-Linked (X-linked) Inheritance ; Has to do with sex chromorsome; XY male XX female
- 50/50 daughter will be a carrier, 50/50 make will be expressor; Mom may carry but male
will express VISE VERSA (Ex. hemophilia just male)
- Chromosome Alterations; Trisomy- down syndrome
- Amniocentesis can confirm alterations
- Common Genetic Diseases: Sickle cell anemia - aa, Cystic fibrosis , Tay-Sachs disease - common
in jewish decent, P K U Huntington’s disease, Hemophilia (X-linked) - male, Duchenne’s
Muscular Dystrophy (X-linked) - male
Fundal height
- Flat knees bent, palpate for fundus/ top of uterus (ridge) gives an idea of how far along pt is
12 weeks 16 weeks 20 weeks
ANTEPARTUM STAGE - Occurs From first day of missed period to labor
Signs of pregnancy: Presumptive, Probable, Positive. - (basically levels of surness)
Presumptive: Patient PRESUMES they are pregnant for any of the following reasons.
- Experiencing; 0 periods, N/V, Fatigue, ↑ Urination, Breast Change (tenderness or
darkness) , Quickening; first flutter of movements (between 14 - 18 weeks).
- Does not guarantee that pt is pregnant, this the moms interpretation
Probable: These are signs a PROVIDER notices the following…
- The provider may note; Enlarged abdomen, + pregnancy test
- Hegar’s sign - softening of the Uterus in cervix/the whole lower segment of the uterus
- Chawhick’s sign - Blushing/Blue/purple coloring of vaginal mucosa
- Goodell’s sign - Softening of just the cervical lip (L in lip and L in Goodell to distinguish
from Hegar’s)
- BUT these are still not concrete even though the MD notes these signs.
Positive: These are the ONLY things that can POSITIVELY PROVE pregnancy!
- Provider will see fetal movement
- Palpate fetus after 20 weeks using Leopold's maneuver
- Use fetal sonography to see heartbeat @ 10-12 weeks
Naegel’s Rule - figures out E.D.D
- Take first day of last pd., count back 3 months, add 7 days, add year to reflect birth.
Nutrition - Tied to BMI
- Must teach pt. From preconception to pregnancy, incorporating diet and physical activity & get
baseline @ first appointment.
- Teaching points:
- Appropriate portion size, 300 additional calories, rinse raw fruits/veggies, 8-10 glasses
of water per day
- Prenatal vitamins- importance of folic acid (4mg-.6mg daily), Calcium, magnesium,
Vitamin D, iron (absorbed well with citrus/vitamin C)
- Special diets with or risk for HTN (DASH- limit trans/saturated fat & excessive sugar)
- What to eat?
- Foods from all food groups: Fresh fruits, veggies, lean protein, low fat or non fat dairy
foods, whole grains, small amounts of healthy fats, iron rich foods (apricots, beans,
legumes, leafy greens)
- What to Avoid?
- Caffeine (<200mg daily), fish w/ high levels of methylmercury (king
mackerel/shark/swordfish/tilefish), unpasteurized juices/dairy products, live cultured
foods, raw sprouts, soft cheese (brie/feta), Smoked seafood, unheated deli meats or
hot dogs,
, - Make sure ALL meat/fish/eggs/seafood are FULLY cooked
- Pt. should gain weight as follows
- 1st trimester = 1-5lbs
- 2nd & 3rd = .5lb-1lb per week
- Weight gain related to BMI
- Underweight pt categorized: BMI less than 18.5; expected to gain 28-40lbs
- Normal weight pt categorized: BMI of 18.5-24.9; expected to gain 25-35lbs
- Overweight pt categorized: BMI 25.0-29.9 ; expected to gain 15-25lbs
- Obese pt categorized: BMI greater than 30.0; expected to gain 11-20lbs
Exercise
- Pt. basically should keep prepregnancy routine unless MD says otherwise
- No reg routine? MD recommends walk 3x a week for 20 mins
- BUT of course pt needs to avoid potential abdominal trauma/falls + overheating, or supine
positioning
- STOP exercise if experiencing any abnormals;
- Vag bleeding, cramping, leakage of fluid, decreased fetal movement, dizziness, HA,
chest pain, calf pain, dyspnea
- EXTREMELY SERIOUS WARNING SIGNS: SEE MD
- Dysuria, alt blurred vision, flashes of light, severe epigastric pain elevated temp,
persistent vomiting THIS PERSON IS PHYSICALLY ILL
Fetal Development
- What forms when? If there is a malformation with one system odds are whatever develops at
the same time will also have issues!
- 4 weeks: HEART BEAT, brain stem formed from anterior neural tube, limb bulbs, GI system starts
to form (just tubes, bulbs and beats at this point - most people don’t even know they’re preg
yet so not much is going on)
- 6 weeks: 12mm, primitive skeletal shape, heart chambers, respiratory system begins, ear
formation, BY 8 WEEKS ALL BODY ORGANS ARE FORMED (way more going on ppl are usually
figuring out they’re preg)
- 12 weeks: 8cm, ossification of skeleton begins, liver produces red cells, palate in mouth formed,
skin is pink, thyroid hormone presents, insulin present in pancreas
- Think: 12 weeks, 12 is a preteen when all the hormones start (insulin, thyroid, +mouth
formation cause they get more sassy)
- By 8-12 weeks HR can be seen via ultrasound
- 16 weeks: 13.5 cm, meconium begins to collect in the intestines, kidneys assume shape, hair on
scalp Harmony test can be done by 13 weeks, sex is seen, starts to look like a baby
- 20 weeks: 19 cm; myelination of spinal cord begins, suck/swallow, vernix protects body,
surfactant production brain appears mature (FEELS MOVEMENT, baby has all these new abilities
makes sense b/c it's at age of viability)
- 40 weeks: 40 cm, adequate surfactant, vernix skin folds, lanugo on shoulders, earlobes formed,
sex aparent , smooth polished skin (baby is done cooking)
, Prenatal Labs - ID dangers/complications to mom and baby w goal of early intervention!
- CBC - Infection, blood disease
- Serology (RPR/VDRL) - Disease testing / STDS
- HIV - Mandatory in 1st and 3rd trimester
- Blood typing, RH, antibody screen. *If RH- check for presence of anti RH antibodies if the baby is
+, which we assume if we let her get sensitized NEXT pregnancy will be attacked
- Rubella TITER, mom Should be immune. If not MMR is a live vaccine WILL NOT GIVE to preg
mom. After birth she can get it but CAN’T get preg again for ONE MONTH
- Hepatitis B
- Hemoglobin electrophoresis; Things like sickle cell
- TB; WANT Below 10 or NEG … greater = exposed. Tests by PPD or t-spot (which is used more)
- Prenatal Genetic testing
- Urinalysis/ Culture: looking for INFECTION like UTI b/c it can cause preterm labor. Watching for
PROTEIN for PREECLAMPSIA and GLUCOSE for DIABETES
- Vaginal exam; for Infections, cancers or any abnormals
- Gonorrhea/chlamydia culture; checked in 1st and 3rd trimester
- Drug screening; Only done with consent, we are mandatory reporters so child protective
services can be called with suspicion, may involve case worker first. First stool can be drug
tested - is it safe for baby to go home with mom?
Inheritance pattern
- Autosomal Dominant; STRONG, only need one altered gene to give baby 50/50 chance of having
alteration (ex. Marfan, Dwarfism)
- Autosomal Recessive; Weak, Both parents need to have weak gene or trait
- 25% to express gene, 25% wont be an expresser or carrier, 50/50 baby carries (Ex. sickle
cell; test mom/dad)
- Sex-Linked (X-linked) Inheritance ; Has to do with sex chromorsome; XY male XX female
- 50/50 daughter will be a carrier, 50/50 make will be expressor; Mom may carry but male
will express VISE VERSA (Ex. hemophilia just male)
- Chromosome Alterations; Trisomy- down syndrome
- Amniocentesis can confirm alterations
- Common Genetic Diseases: Sickle cell anemia - aa, Cystic fibrosis , Tay-Sachs disease - common
in jewish decent, P K U Huntington’s disease, Hemophilia (X-linked) - male, Duchenne’s
Muscular Dystrophy (X-linked) - male
Fundal height
- Flat knees bent, palpate for fundus/ top of uterus (ridge) gives an idea of how far along pt is
12 weeks 16 weeks 20 weeks
