THE PREGNANT WOMAN
Transcript: Cardiovascular Placental Hormones Anatomy & Physiology Musculoskeletal Bickley, L. S. (2007). Bates’s Guide to Physical Examination and History Taking. (10th ed). Philadelphia, PA: Lippincott Williams and Wilkins. No menses Nausea with or without vomiting Weight loss Fatigue CRH & ACTH Follow Ups Stimulates lactotrophs in the anterior lobe of the pituitary gland to get the breast tissue ready for lactation Hegar's sign Health Promotion and Counseling Modified Leopold's Maneuvers Third Maneuver (Lower pole) Turn and face the women's feet. Using the flat palmar surfaces of the fingers of both hands and, at the start, touching the fingertips together, palpate the area just above the symphysis pubis (this tells you the presenting part the head and buttocks) Early sign of pregnancy where there is an increase vascularity throughout the pelvic. The vagina takes on a bluish or violet color Expected Weeks of Delivery Count in weeks from the first day of the last menstrual period (LMP) Use the date of conception Expected date of Delivery (EDD) Negele's Rule- (assuming regular 28- to 30-day menstrual cycle EDD by adding 7 days to the first day of the LMP, subtract 3 months, and add 1 year. Extremities General inspection of extremities by having the women sitting down or lying on her left side Inspect the legs for varicose veins Inspect the hands and feet for any edema. Palpate pretibial, ankle, and pedal edema. Check knee and ankle reflexes Modified Leopold's Maneuvers First Maneuver (Upper pale) Stand at the women's side, palpate gently with the fingertips to determine what part of the fetus is in the upper pole of the uterine fundus. Rising progeserone levels relaxes tone and concentration in the ureters, causing hydronephrosis, and in the bladder, increase risk for bacteriuria Techniques of Examination Weeks of Gestation and Expected Date of Delivery Modified Leopold's Maneuvers Beginning at 28 weeks of gestation the examiner may maneuver the baby to determine fetus position in relating to which end of the fetus is presenting at the pelvic inlet (head or buttocks) Weight gain Lumbar Lordosis Ligamentous laxicity in the sacroiliac joints and the pubic symphysis, to ease the passage of the baby through the birth canal Enlargement of the breasts and the uterus Remains normal size but estrogen and stimulation of the Thyrotropin receptor lead to fluctuation in free T4 and T3 levels Assessment The palpable softening at the isthmus is an early diagnostic sign of pregnancy Past Family Medical History Special Techniques Questions Progesterone Speculum Examination Inspect the cervix for color, shape, and healed lacerations Take pap smears-vaginal and cervical specimens Inspect the vaginal walls for color, discharge, rugae, and relaxation. A bluish or violet color, deep rugae, and increase milky white discharge, (leukorrhea) are normal Genitalia/ Anus/ and Rectum Inspect external genitalia-noting hair, color and scars. Note enlarge of the labia and clitoris, which is normal Inspect the anus for hemorrhoids. If present, note their size and location. Palpate Bartholin's and Skene's glands. No discharge or tenderness should be present Check for cystocele and rectocele During pregnancy, hormonal changes lead to extensive anatomical and physiologic changes in every major body system The Inital Prenatal Visit Confirmingthe pregnancy Assessing the health status of the mother and any risks for complications Counseling to ensure birth of a healthy baby. Special Techniques Corticotrophin-releasing hormone and adrenal adrenocortitropic hormone produce a state of relative hypercortisolism that may be a trigger for labor Excerise Immunizations Chadwick's sign Weight Gain Thorax and Lungs Inspect for chest for symmetry elevation of the diaphragm and increased chest diameter is normal. Heart Palpate the apical pulse. May be slighter higher in advance pregnancy. Auscultate the heart. A venous hum and systolic or continous mammary souffle is normal. Nutrition Posterior Pituitary Gland Prior pregnancies (complications) Delivery process- vaginally, assistance of forceps or vacuum, or by cesarean section Birth weight of prior children Growth, retarded, or large for gestational age? Estradiol General Survey Reference Expected Height of the uterine by months of pregnancy How much additional calories should the pregnant woman consume in her diet each day: A- 200 Kilocalories B- 300 Kilocalories C- 400 Kilocalories D- 500 Kilocalories You are assessing the current state of health of a pregnant woman. which of the following past medical history is important: A- Hypertension B- Asthma C- Cardiac conditions D- All of the above Pregnant women should engage in moderate exercise for 30 minutes a day Women who exercise before pregnancy should do it 3 times per week. Women initiating exercise should be cautious and consider programs specfic for pregnant women Modified Leopold's Maneuvers Fourth Maneuver (confirmation of the presenting part) With your
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