Presumptive Signs of Pregnancy

• Amenorrhea

• Nausea / Vomiting

• Breast changes

• Urinary frequency

• Fatigue

• Quickening

Probable Signs

• Braxton-Hicks contractions

• Ballottement

• Positive pregnancy test

• Goodell’s sign

• Hegar’s sign

• Chadwick’s sign

Positive Signs

• Visualization of fetus

• Fetal heart sounds

• Fetal movement

Physiological Changes
First Trimester

• Uterus

– ammenorrhea

– 12 weeks rises out of pelvis

First Trimester

• Cervix

– Goodell sign

– Hegar sign

– Chadwick sign

– McDonald’s sign

First Trimester

• Vagina

– pH 4 to 6.5

– Leukorrhea

First Trimester

• Breast

– tender

– Montgomery glands

– darkening of nipple and areola

First Trimester

• Cardiac changes

– blood pressure

– blood volume

Kidney’s

– glucose

– protein

First Trimester

• Skin

– linea nigra

– hair growth

Gastrointestinal

appetite changes

epulis

Physiological Changes
Second Trimester

• Uterus

– 20 weeks level of umbilicus

– Shape

– Palpable fetus

– Quickening

– Braxtons-Hicks contractions

Second Trimester

• Cervix

– mucous plug

– vaginal mucosa

Breast

enlarges

darkens

Second Trimester

• Cardiovascular

• pulse rate

• blood pressure

• blood volume

• Respirations

• Kidneys

• glomerular filtration rate

Second Trimester

• Muscuoskeletal changes

– physiologic lordosis

Skin changes

– striae gravidarum (stretch marks)

• Stomach

• Gallbladder

Physiological Changes
Third Trimester

• Uterus

– lightening

– braxton-hicks

Cervix

– ripens

Third Trimester

• Cardiovascular

• Respiratory

• Kidney

• Muscuoskeletal

Prenatal Care

• Growth and development of fetus

• Monitor maternal changes

• Diagnosis disorders

• Assess nutrition of mother

• Education

OB Exam
Nagele’s Rule

• Dating a pregnancy

• Add 7 days

• Subtract 3 months

• Add 1 year (except for Jan., Feb., March)

Example

• LMP: 10 Sept. 2003

• *10 plus 7 days = 17

*9th month, subtract 3 months = 6th month or June

*2003 plus 1 year = 2004

EDD is 17 June 2004

OB Exam (conti.)

• History taking

– health history

– menstrual history

– family history

– social history

OB Exam (conti.)

• Number of children

• Gravidity: refers to pregnancy

• Parity: pregnancies that have reached viability

• Viability: capacity to live outside womb, 22 - 24 wks.

• Abortion: termination of pregnancy before viability

Two Digit System

• Primigravida: first pregnancy G1 P0

• Primiparous: completed pregnancy reaching viability G1 P1

• Multigravida: two or more pregnancies G2 P1

• Multiparous: completed two or more pregnancies to viability G2 P2

Example

• First pregnancy: G1P0

• Second pregnancy: G2P1

• The second pregnancy ends at 18wks G2 P1

• Or Second pregnancy survives and delivers at 34wks G2P2

Example

• First pregnancy delivers triplets at 36 weeks G1P1

• Increase parity by one number only if pregnancy has reached viability, either born alive or stillborn

Five Digit System

• G; gravidity, number of pregnancy

• T: term births, greater than the end of 37 weeks

• P: premature births, delivered before 38 weeks

• A: abortions, before viability, less than 22 to 24 weeks

• L: living children

OB Exam (conti.)

• Lab work

– skin

– urine

– blood

– antibody screen

– smears

OB Exam (conti)

• Physical exam: head to toe

• Childbirth education

• Birth plan

• Schedule return visits

Nutrition

• Metabolic needs

• Weight gain

• Protein needs

Nutrition

• Water

• Iron

• Calcium

• Fat soluble vitamins

• Water soluble vitamins

Nutrition (conti.)

• Folic acid

• Foods to avoid

• Nutrition for teen pregnancies