OB | Regular Pregnancy
STAT Stitch Deep Dive Podcast Beyond The Bedside · Regular Guy
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Show Notes
1. Diagnosing and Dating Pregnancy Pregnancy manifestations are categorized into three groups. Presumptive signs are subjective client experiences, such as amenorrhea, fatigue, nausea, and quickening. Probable signs are objective provider findings, including abdominal enlargement, positive hCG tests, Hegar’s sign (softening of the lower uterus), and Chadwick’s sign (bluish cervical mucosa). Positive signs uniquely confirm pregnancy and include auscultated fetal heart sounds, ultrasound visualization, and provider-palpated fetal movement. To calculate the estimated delivery date, use Naegele’s rule: subtract 3 months from the first day of the last menstrual period, add 7 days, and adjust the year. Obstetric history is recorded using the GTPAL acronym: Gravidity (pregnancies), Term births (38+ weeks), Preterm births (20-37 weeks), Abortions (prior to viability), and Living children.
2. Key Physiological Adaptations Maternal cardiac output and blood volume increase by 30% to 50%, and the maternal heart rate increases by 10 to 15 beats per minute. A critical risk is supine hypotensive syndrome, where the heavy gravid uterus compresses the vena cava when the client lies flat, severely decreasing venous blood flow; the client should be placed in a left-lateral side-lying position to alleviate pressure. The expected fetal heart rate (FHR) baseline is 110 to 160 beats per minute. Skin changes include chloasma (facial pigmentation), linea nigra (dark abdominal line), and striae gravidarum (stretch marks). Psychosocially, first-trimester ambivalence (conflicting feelings) is a completely normal response that typically resolves before the third trimester.
3. Prenatal Care & Critical Screenings Between 18 and 30 weeks, fundal height in centimeters approximately equals the number of weeks of gestation. Fetal movement is usually felt between 16 and 20 weeks. Clients must monitor fetal kick counts; fewer than 3 movements per hour or a complete cessation for 12 hours requires immediate provider evaluation. Critical routine screenings include:
- Maternal serum alpha-fetoprotein (MSAFP): Drawn between 15-22 weeks to screen for neural tube defects (high levels) or Down syndrome (low levels).
- RhO(D) immune globulin: Administered IM at 28 weeks strictly for Rh-negative clients.
- Group B Streptococcus (GBS): Cultures are taken at 35 to 37.5 weeks of gestation.
- 1-hour glucose tolerance test: Screens for gestational diabetes; readings >140 mg/dL require a 3-hour diagnostic follow-up test.
4. Managing Common Discomforts To manage first-trimester nausea, clients should eat crackers or dry toast before rising in the morning and avoid an empty stomach. Urinary tract infections (UTIs) are common; clients should wipe from front to back, avoid bubble baths, and drink 8 glasses of water daily. Second and third-trimester backaches are relieved by performing pelvic tilt exercises and using proper body mechanics. For leg cramps, clients should extend the affected leg and dorsiflex the foot toward the head.