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Concepts Of Maternal (NUR 4130) OB Exam 1 Study Guide (The Bible)

John Marsh
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Nova Southeastern University

Concepts Of Maternal-Child Nursing And Families (NUR 4130)

OB Exam 1 Study Guide (The Bible)

Subjective (Presumptive) Changes
 The subjective changes of pregnancy are the symptoms the woman experiences and reports. Because they
can be caused by other conditions, they cannot be considered proof of pregnancy
 Amenorrhea, absence of menses, is the earliest symptom of pregnancy (with regular periods). It is not a
reliable sign of pregnancy by itself, but if it were accompanied by consistent nausea, fatigue, breast
tenderness, and urinary frequency, pregnancy would be very likely.
 Morning sickness – Nausea and vomiting that occurs early in the day (1st Trimester)
– Women who experience NVP often have a more favorable pregnancy outcome than those who do
 Excessive fatigue (1st & 3rd trimester)
 Urinary frequency as the enlarging uterus presses on the bladder (1st and 3rd trimester)
 Breast changes (tenderness)
 Quickening (feels like gas pains and is the moment in pregnancy when the women starts to feel/perceive fetal
movements in the uterus), occurs 16-20 weeks after the LMP
Objective (Probable) Changes
 An examiner can perceive the objective changes that occur in pregnancy. Because these changes can have
other causes, they do not confirm pregnancy.
 Changes noted in the uterus and vagina during pregnancy within the first three months of pregnancy
– Softening of the cervix (Goodell’s sign)
– Dark violet coloration of cervix, vagina, and vulva (Chadwick’s sign)
– Softening of lower part of uterus, the isthmus (Hegar’s sign)
– An ease in flexing of the body of the uterus against the cervix (McDonald’s Sign)
– Progressive uterine enlargement – Know
o The fundus of the uterus is palpable just above the symphysis pubis at about 10-12 weeks’
o At the level of the umbilicus at 20 to 22 weeks’ gestation
o Between 24-34 weeks the height of the fundus correlates with the weeks of gestation
o Note: Woman can have other things growing here that aren’t a baby such as fibroids
– Enlargement of the abdomen (2nd Trimester she said this is when the uterus becomes an abdominal
o Braxton-Hicks contractions can be palpated most commonly after the 28th week. Also
termed false labor.
o Uterine Souffle may be heard when the examiner auscultates the abdomen over the uterus.
Soft blowing sound at the same time as the maternal pulse.
– Funic soufflé is the soft blowing sound of the blood pulsating through the umbilical
cord which occurs at the same time as the fetus’s heart rate.
 Changes in Pigmentation (linea nigra, chloasma and striae)
 Fetal outline may be identified by palpation in many pregnant women after 24 weeks’
– Ballottement is the passive fetal movement elicited when the examiner inserts two
gloved fingers into the vagina and pushes against the cervix. This action pushes the
fetal body up and as it falls back the examiner feels a rebound.
 Pregnancy test
– A positive hCG test is not necessarily and indicator of pregnancy because it can
indicate molar masses and/or cancer, while low levels are associated with an
ectopic pregnancy
Diagnostic (Positive) Changes
 The positive signs of pregnancy are completely objective, cannot be confused with a pathologic state, and
offer conclusive proof of pregnancy
 Fetal heartbeat: detectable by Doppler ultrasound as early as 10-12 weeks of pregnancy
 Fetal movement: detected by echocardiography or transvaginal sonography but palpable after about 20
weeks of pregnancy
 Visualization of the fetus by ultrasound examination confirms a pregnancy. The gestational sac can be
observed by 4-5 weeks of gestation. Transvaginal ultrasound has been used to detect a gestational sac as
early as 10 days after implantation. Fetal heart activity by 6-7 weeks.
Reproductive System pg. 365
 The change is primarily the result of the enlargement (hypertrophy) of the preexisting myometrial cells in
response to the stimulating influence of estrogen and the distention caused by the growing fetus.
 Shows progressive growth; moves from an oval shape to a globular shape and it starts looking like a light
 Hegar’s sign: softening of the lower uterine segment
 Braxton-Hicks contractions: irregular uterine contractions (false contractions) that begin around the 4th
month of pregnancy and can be mistaken for true labor contractions. These contractions have no effect on
the cervix.
 Leopold’s maneuvers: feeling and palpating the abdomen to evaluate the position and presentation of the
 By 20 weeks gestation, the fundus, or top of the uterus, is at the level of the umbilicus and measures 20 cm.
 The fundus reaches its highest level, at approximately 36 weeks, when it reaches the xiphoid process.
Because it pushes against the diaphragm, many women experience shortness of breath.
 Manipulating the uterus to determine the position of the baby
– Fundus: the top of the uterus
– Isthmus: Middle of the uterus
– Cervix: lover uterus
 Without a tape measure:
– At the pelvis = 12 cm
– Between the pelvis and the umbilicus = 16 cm
– At the umbilicus = 20 cm



Concepts Of Maternal (NUR 4130) OB Exam 1 Study Guide (The Bible)

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