Normal Pregnancy

Contraction	exhibits wavelike pattern that begins slowly climbing (increment) to a peak (acme) and decreases (decrement)
Duration	beginning of one contraction to the end of the same contraction
Frequency	beginning on one to the beginning of ANOTHER contraction
Interval	resting time BETWEEN contractions allows for placental perfusion
Probable signs of pregnancy	positive pregnancy test (HCG), uterine and cervical changes (ballottement (palpate and bounce floating area and feel its rebound), Braxton-hicks, palpation of fetal parts, uterine souffle
hCG (human chorionic gonadotropin)	This stimulates the corpus luteum to produce estrogen & progesterone. Secreted by the placenta and presents in blood and urine pregnancy tests
uterine souffle	soft, blowing sound made by the blood in the arteries of the pregnant uterus and synchronous with the maternal pulse
Gravida	The number of times the woman has been pregnant, regardless of whether these pregnancies were carried to term. A current pregnancy, if any, is included in this count.
Para	number of deliveries at 20+ weeks (not # of babies delivered but the # of deliveries)
primigravida	a woman who is pregnant for the first time
multigravida	a woman who has been pregnant more than once
nullipara	no births (a woman who has not given birth to a viable offspring) none maintained past 20 weeks
Primipara	first sustained birth past 20 weeks
Multipara	multiple births past 20 weeks
TPAL	Term, preterm, abortion, living children
Term	(38-42 weeks)
Preterm	(20-38 weeks)
Abortion	Abortions (induced & spontaneous SAB) (less than 20 weeks)
Living children	Living children (currently living)
Nagele’s Rule	1st day of last period – 3 months + 7 days = estimated date of birth

Signs

Chadwick’s sign	Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascularity of the pelvic organs
Goodell’s sign	softening of the cervix caused by pelvic vasoconstriction
Hegar’s sign	Softening of the isthmus of the cervix

Pregnancy

advantages of home pregnancy test	readily available, uncomplicated, convenient, 97% accurate, min time, cost-effective
Disadvantages of home pregnancy test	must be able to follow directions or can lead to improper collection or errors in performing and reading
false positives	hematuria and proteinuria, anticonvulsants, ASA, tranquilizers, MJ
false negative	diuretics and promethazine
Positive signs of pregnancy	audible fetal heartbeat, fetal movement felt by examiner, ultrasound visualization of a fetus (may be visible as early as 3 weeks)
Normal aches of pregnancy	N/V, back pain, round ligament pain, UA frequency, varicosities, constipation, hemorrhoids, leg cramps, heartburn
Warning signs of pregnancy	vaginal bleeding, fluid gushing or leaking from vagina, persistent vomiting, , visual disturbances, dizziness, persistent headache, abdominal pain, edema, dysuria, oliguria and a notable decrease in fetal movement

Physiological Changes

Heart
- – VERY Increased Preload
- – Increased HR
- – Decreased SVR
Pulmonary
- – Increased total volume
- – Decreased functional residual capacity
Clotting
- – Increased adhesion (due to increased vWf)
- – Increase in factors 7,8,and 10
- – Decrease in protein C and S
Renal
- – Increased GFR
- – Decreased Creatitine
- – Obstructive uropathy usually occurs at pelvic brim
Gastrointestinal
- – GERD
- – Nausea
- – Constipation
- – Iron Deficiency
- – Gallbladder dx

First Trimester

Uncertainty
- —-Incorporation and integration of the fetus as an integral part of the woman.
Ambivalence
- —–emotions that come with early pregnancy
Self as the primary focus
- —-Baby not perceived as a reality.
- —-Fetus is not perceived as a separate object
- —-Interest and concern about their bodily and emotional changes.
Psychological Task
- – Needs to be able to say “I am Pregnant”

Second Trimester

Fetus as the primary focus
- —Sees fetus as a separate object and not an extension of self.
- —Picture the fetus as a newborn infant.
- —Assign sex and describe with specific characteristics.
Narcissism and Introversion
- —Wants to do the right things to protect herself and her baby
Body Image
Psychological Task
- – Needs to be able to say “I am going to have a baby”

Third Trimester

Vulnerability
- —Worry that baby may be lost or harmed
Increasing dependence
Preparation for birth
- —Planning baby’s arrival at home.
- —Decide on the method of feeding.
- —Acceptance of demands baby will make on parents.
- —More confident in knowledge about labor and delivery.
- —Interest in child care and planning for the future.
Psychological Task
- – Needs to be able to say “I am going to be a parent.”