Nursing 209

N209: Reproductive Health Study Guide

Enlarged uterus; change in shape Ballottement of fetus

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• Positive o Presence of gestational sac on ultrasound o Auscultation of fetal heart tones via Doppler at 9-10 weeks or via fetoscope at 18-20 weeks o Palpation of fetal movements by trained examining physician or midwife after 20 weeks o Observation of fetal cardiac motion on ultrasound • Other pregnancy symptoms o Implantation bleeding: Occurs when the fertilized egg attaches to the lining of the uterus, about 10-14 days after conception o Mild cramping o Mood swings o Dizziness: Pregnancy causes blood vessels to dilate and blood pressure to drop o Constipation: Hormonal changes slow down digestive system o Varicose veins Pregnancy causes changes in all maternal organ systems • Most return to normal after delivery • Changes are greater in multifetal vs. singleton pregnancy Cardiovascular changes: • Cardiac output increases by 30-50%; peaks between 16 and 24 weeks • Peak levels remain until after 30 weeks, then become sensitive to body position; changes occur most in positions that obstruct the vena cava (recumbent position) • Begins decreasing slightly from 30 weeks until the beginning of labor • During labor, cardiac output increases another 30% • Drops rapidly after delivery to about 15-25% above normal • Reaches pre-pregnancy level at about six weeks postpartum • Increase is due mainly to demands of uteroplacental circulation • Physical findings include increase in HR from 70 bpm to 90 bpm; decrease in maternal BP during the second trimester due to expansion of uteroplacental circulation and a decrease in systemic vascular resistance • Increased frequency of functional murmurs and accentuated heart sounds • Premature atrial and ventricular beats are common 3.3 Physiological Changes in Pregnancy •

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