Number of pregnancies in which the fetus/fetuses have reached 20 weeks gestation

Note: NOT the number of fetuses born

Last normal menstrual period

GA is determined from the date of LNMP

Five digit separated by hyphens (ex: 3-1-1-1-2)

Gravida-term-preterm-abortions-living-children

Gravida/Para (pregnancies/ deliveries after 20 weeks gestation)

ex: G3P2

• Subjective changes 
• Felt by the woman and reported to provider 
• Could have other possible causes than pregnancy

• Amenorrhea 
• Breast changes (enlargement, tenderness) 
• N/V (morning sickness) 
• Urinary frequency 
• Fatigue 
• Quickening

• Objective changes 
• Observed by the examiner 
• Mainly related to physical changes in the uterus and pelvic organs

• Abdominal enlargement 
• Positive pregnancy test 
• Goodell's Sign 
• Chadwick's Sign 
• Hegar's Sign 
• Ballottement 
• Lightening

• Noted at 5 weeks 
• Softening and velvety appearance of cervical tip (os)
• Caused by increased vascularity and volume, edema 
• Cervix bleeds easily

• Noted at 6-8 weeks 
• Violet-bluish color of the cervix and vaginal mucosa 
• Due to increased blood flow and volume

• Noted at 6-12 weeks 
• Softening and compressibility of lower uterus (isthmus) 
• Due to pelvic congestion and edema

• Noted at 16-18 weeks 
• Passive movement of the fetus 
• Floating structure rebound
• Not done often (invasive)
• Insert fingers into vagina, tap up on cervix, should feel tap back (as baby floats back down)

• Fetal descent into pelvic cavity 
• Primipara: 2 weeks before labor 
• Multipara: Concurrent with labor

• Completely objective 
• Attributed ONLY to the presence of the fetus

• Ultrasound visualization 
• Fetal heart tones 
• Fetal movement palpated (by examiner, not just mom)

• Hormone made by the chorionic villi 
• Found in blood and urine of pregnant women 
• Blood--detected 6 days after conception (20 days after LMP) 
• Urine--detected 14 days after conception (28 days after LMP)

• EDC (estimated date of confinement)
• EDD (estimated date of delivery) 
• EDB (estimated date of birth)

• Wheel used to calculate due date 
• Place arrow "first day of last period" on date of LMP, then read EDB at arrow labeled 40

• Formula used to estimate date of birth/ delivery 
• Method A: Add 7 days to the 1st day of the LMP, then count forward 9 months 
• Method B: Subtract 3 from the month that LMP occurred, and add 7 days and 1 year

• 1st trimester: acceptance 
• 2nd trimester: continuation of pregnancy 
• 3rd trimester: separation

• RR: unchanged or increased slightly
• Increased O2 need by fetus and mom
• Increased chest expansion (b/c of estrogen)
• Elevated diaphragm (up to 4 cm)
• Thoracic breathing replaces abdominal breathing
• Increased tidal volume (30-40%)
• Nasal stuffiness
• Epistaxis

• Enlargement 
• Heightened sensitivity 
• Heaviness, tingling, fullness 
• Dilated blood vessels 
• Darkening of nipples and areola 
• Montgomery's tubercles 
• Colostrum

• Pregnancy gingivitis (hypertrophy and bleed)
• Heartburn 
• N/V (morning sickness)
• Enhanced absorption of nutrients
• Intestines and stomach displaced
• Hemorrhoids and constipation 
• Gastric emptying time and intestinal motility delayed

• Hypertrophy of smooth muscle 
• Increased length of vaginal vault 
• Loosened connective tissue 
• Increased thick white secretions (leukorrhea) 
• Mucous plug

• Hyperpigmentation
• Chloasma (melasma)/ mask of pregnancy
• Acne vulgaris, dermatitus, spider veins
• Striae gravidarum  
• Linea nigra

• Weight gain 
• Increased need for H20 
• Increased fluid retention
• Increased caloric and nutritional need

• Increased lumbosacral curve 
• Altered center of gravity (shifts forward)
• Duck waddling gait
• Increased mobility of pelvis (due to softening of cartilage and ligaments)
• Diastasis

• Increased blood volume, heart rate, and cardiac output 
• BP--stays the same or decreases slightly 
• Heart enlargement, murmurs 
• Increased RBCs and WBCs (in 2nd and 3rd trimester) 
• Decreased Hgb and Hct
• Increased plasma

• Increased urinary frequency (early and late in preg)
• Increased bladder capacity
• Increased GFR and renal plasma flow
• Decreased BUN, creatinine, and uric acid
• Increased susceptibility to UTIs
• Glucosuria and albuminuria common (trace amounts)

• Increased size, weight, and connective tissue 
• Braxton Hicks contractions 
• Cervical softening

• Placenta: increased estrogen, progesterone, hCG; produces HPL
• Pituitary: increased prolactin (anterior) and oxytocin (posterior)
• Thyroid: increased hormone production and size
• Pancreas: changing insulin production; diabetogenic effect of pregnancy due to HPL

• Bring nutrients to fetus 
• Bring waste away from fetus 
• Produce HPL, estrogen, progesterone, and hCG

• Top of uterus 
• Height measured to estimate duration of pregnancy (less accurate after 36 weeks)

• Irregular, painless contractions 
• Begin at 16 weeks 
• Do not increase in intensity or frequency (like true labor will) 
• Do not cause cervical dilation and effacement (like true labor does)

• Sound made by blood in the uterine arteries 
• Synchronous with mom's pulse

• Sound made by blood rushing through umbilical vessels 
• Synchronous with fetal heart rate (FHR) 
• Much faster than mom's pulse and uterine souffle

• 14-16 weeks in multipara
• 18-20 weeks primipara 
• "Fluttery" feeling 
• First time mom feels the fetus move

• AKA operculum 
• Barrier against infection during pregnancy

• Sebaceous glands of areola 
• Protect and prepare nipples for nursing

• Creamy, yellowish to orange pre-milk fluid 
• Present from 16 weeks gestation 
• Loaded with antibodies

• Occurs when laying supine 
• BP drops due to compression of the ascending vena cava 
• Faint feeling occurs

• Caused by increased plasma in relation to RBCs, Hct, and Hgb 
• Normal, but still treat with iron supplement 
• If Hgb <10 g/dl or Hct < 33%, consider true anemia

• Stretch marks
• Caused by separation w/in underlying collagen
• Usually fade after birth but never disappear completely

• Hyperpigmentation of skin over the cheeks, nose, and forehead
• Intensified by the sun
• Usually fades postpartum

• Separation of rectus abdominus muscles
• Gradually regain tone postpartum
• Separation can persist postpartum

• Carpal tunnel syndrome
• Functional changes (ex: increased clumsiness RT smooth muscle relaxation)

• Early pregnancy: N/V
• Mid and late pregnancy: increased appetite
• Cravings common
• Changes in taste and dietary intake
• Pica: non-food cravings

• AKA human chorionic somatomammotropin
• Growth hormone 
• Contributes to breast development
• Decreases maternal metabolism of glucose
• Increases amount of fatty acids for metabolic needs

• Stimulates let-down of milk during lactation
• Stimulates uterine contractions

• Promotes enlargement of genitals, uterus, and breasts
• Relaxes ligaments and joints
• Causes fat to deposit in SC tissues of back, abdomen, and thighs for use in pregnancy and lactation

• Relaxes smooth muscle and decreases uterine contractility 
• Helps maintain pregnancy and prevent miscarriage

• Short amount of time to get on blood sugars and fix them
• Baby will absorb glucose but not insulin; grows fast and can become hypoglycemic very fast postpartum
• Start testing mom's glucose levels 24 weeks in (gestational diabetes)

• First trimester: weeks 1-13
• Second trimester: weeks 14-26
• Third trimester: weeks 27-40

• Weeks 4-28: every 4 weeks (once/month)
• Weeks 28-36: every 2 weeks (twice/month)
• Weeks 36-birth: every week

• CBC, WBC w/ differential
• Hbg/ Hct
• Blood type, Rh factor
• Test for antibodies vs. Rubella, Hepatitis B, HIV
• Urinalysis, urine culture, and renal function tests
• PAP-smear, vaginal/rectal smears (STDs)
• 1-hour glucose tolerance test (28th week except for high-risk women)

• No live virus vaccines (chickenpox, MMR)
• Approved vaccines: TDaP, rabies, hepatitis B, pneumococcus, influenza
• Flu vaccine provides infant protection for up to 6 months postpartum if given to mom during pregnancy

• Hyperemesis gravidarum
• Chills, fever (infection)
• Burning on urination (UTI)
• Abdominal cramping or pain (possible miscarriage)
• Vaginal bleeding (possible miscarriage)

• Severe and persistent vomiting
• Causes weight loss, dehydration, and electrolyte abnormalities

• Those from 1st trimester
• Fluid discharge from vagina (indicating membrane rupture), vaginal bleeding
• Severe abdominal pain, back-ache, flank pain
• Uterine contractions, cramping before 37 weeks
• Visual disturbances, h/a
• Sudden weight gain (>2 kg/week)
• Absence/ change in fetal movement

• Systolic pressure >140 OR >30 over baseline
• Diastolic pressure >90 OR >15 over baseline
• Mean arterial pressure (MAP) >105 OR >20 over baseline

• About at the umbilicus at 20 weeks
• Should equal number of weeks gestation (+ or - 2cm) from weeks 18-30
• Rise about 1 cm/week from week 20

• Fetal undergrowth
• Can be caused by defcient nutrients, oligohydramnios, etc.
• Often results in low birth weight (LBW) infants

• Multifetal gestation
• Macrosomia (large fetal size)
• Hydramnios (too much amniotic fluid)
• Obesity

• Can be heard at 10-12 weeks with doppler
• Can be heard at 16-20 weeks with stethoscope
• 110-160 bpm

• Maintain pre-pregnancy exercise for 35 min/day, 5 days/week
• Do not exceed pulse 140 bpm
• Excess water needed before, during, and after
• Avoid holding breath and falls
• Decrease exercise as pregnancy progresses
• Avoid hot-tubs and saunas

• 1st trimester: decreases due to n/v and fatigue
• 2nd and 3rd trimesters: increases due to pelvic congestion
• Decreases near term due to discomfort

• Threatened abortion, Hx of multiple miscarriages, incompetent cervix
• After rupture of membranes (ROM)
• Cramping, bleeding
• Multiple sexual partners (infection risk)

• Mother on certain meds
• Certain medical conditions (breast cancer, TB, hepatitis C, HIV)

• For women with inverted nipples
• Use in 3rd trimester for 1-2 hours/day

• Expose nipples to sunlight and air
• Oral stimulation
• Rolling and gently pulling nipples

• Contractions every 10 min or more for 1 hour
• Pelvic pressure/ pain
• Low, dull back or abdominal pain
• Menstrual-like cramps
• Change/ increase in vaginal discharge
• Vaginal bleeding
• Intestinal cramping, with or without diarrhea
• Urinary frequency

• Overall, should gain 25-35 lbs throughout pregnancy
• 2-5 lbs during 1st trimester, then 1 lb per week until end 
• Less/ more required for overweight/ underweight women
• Not enough weight gain = LBW infants and preterm labor risks

• Breast tenderness, tingling, pain
• Urinary urgency and frequency
• Fatigue
• N/V (morning sickness)
• Nasal stuffiness and epistaxis
• Mood swings
• Gingivitis and epulis (hyperemia, hypertrophy, bleeding, tenderness of gums)

• Hyperpigmentation
• Pruritis (non-inflammatory)
• Supine hypotension and bradycardia
• Orthostatic hypotension and syncope
• Pyrosis (heartburn)
• Constipation, flatulence, bloating, belching
• Headaches
• Carpal tunnel syndrome
• Varicose veins
• Round ligament pain
• Joint pain, backache, pelvic pressure

Side-lying position with kenes slightly flexed

Avoid supine position

• Vigorous leg movement
• Avoid sudden changes in position
• Avoid warm, crowded areas
• Avoid hypoglycemia (eat 5-6 small meals per day)
• Sit as necessary

• Limit or avoid gas producing/ fatty foods and large meals
• Sip milk or hot herbal tea for temporary relief
• PCP may prescribe antacid--administer as ordered

Recommend a pregnancy girdle (if varicosities are in perineal area)

Girdle applies pressure to pelvic area to relieve pain

Stretch as uterus grows and can be very uncomfortable

Effleurage (teach mom) can help

Effleurage--light stroking in circles

• Dyspnea
• Insomnia (later weeks)
• Urinary frequency/ urgency (as baby drops)
• Increased anxiety
• Perineal discomfort and pressure
• Braxton Hicks contractions
• Leg cramps
• Ankle edema