Gravodity is the number of times a woman has been pregnant.  Parity is the number of times she has given birth beyond 20 weeks GA or of aninfant weighing more than 500 g.

TPAL is a designamtion of pregnancy outcomes. Term deliveries. Pre-term deliveries, abortuses, and number of living children.

Breast swelling and ternderness

Appearance of the linea nigra from umbilicus to pubis

Telangectasias

Palmar erythema

Amenorrhea

Nausea and vomiting

Quickening-fetal movement

CValculates the estimated date of confinement (EDC), or estimated date of delivery (EDD).

Subtract 3 months from LMP and add 7 days

Increase in cardiac output

Decrease in systemoc vascular resistance thought to be due to the effects of progesterone on smooth muscle

Decrease in BP

Attributed to rise in estrogen, progesterone, and hCG

Occurs in 70% of pregancies

Should resolve vy 14-16 weeks gestation

Prolonged Gastric Emptying Times

Decreased gastroesophageal sphincter tone

Reflux

Ptyalism or spitting

Decreased large bowel motility leading to constipation

Prolonged Gastric Emptying Times

Decreased gastroesophageal sphincter tone

Reflux

Ptyalism or spitting

Decreased large bowel motility leading to constipation

Kidneys increase in size as do the ureters leading to an increase in pyelonephritis.

GFR increases 50%

BUN and creatinine decrease by 25%

Increas in renin-angiotensin system leads to increased aldosterone levels resulting in increased sodium resorption, but sodium levels do not increase thanks to increased GFR

Plasma volume increase by 50%

RBCs increase 20-30% leading to decreased hematocrit

WBCs increase to avg of 10.5 and up to 20 during labor

Slight decrease in platelets

Pregnancy is a hypercoagulable state with increase thromboembolic events with increase is fibrinogen and factors VII-X but bleeding times don't change. Colts thought o be secondary to venous stasis and vessel damage.

In pregancy estrogen is produced in the placenta by circulating plasma-borne precursors which are produced by the maternal adrenal glands.

Fetal well being is correlated with maternal serum estrogen levels.

hCG

Human chorianic gonadotropin

Produced by the placenta to maintain progesteron production by the corpus luteum.

Levels of hCg should double approximately every 48 hours during early pregnancy peaking at weeks 10-12 and declining slight to week 15.

Human Placental Lactogen

Produced in the placenta, rsponsible for ensuring a constant nutrient supply to the fetus.

Causes lipolysis leadingto an increas in circulating fatty acids

Insulin antagonist: diabetogenic leads to increas in insulin and protein synthesis

Produced by the corpus luteum during early pregancy and later by the placenta

Derived from LDL cholesterol and levels increase during pregnancy

Relaxes smooth muscle

Thyroid binding globulin increased by high estrogen levels

T3 and T4 increased by hCG and other placental hormones

Prolactin increases during pregnancy, drops after delivery and returns with suckling

Patient remains euthyroid

Caloric requirement increase by 300kcal/day during pregancy and 500kcal/day while nursing

Pts should gain 20-30 lbs during pregnancy

Increase in protein, iron, folate and calcium are advised.

CBC

henatocrit

Blood type and screen/Rh

RPR

Rubella antibody

hep B Surface antigen

GC

PPD

Pap

UA and culture

VZV titer

HIV

B-HCG if bleeding or cramping

MSAFP/triple screen

Ultrasound

Amniocentesisin AMA (advanced maternal age) pts

Hematocrit

RPR

GLT (glucose loading test)

GC

CXR if + PPD

Group B Strep culture

Percutaneous Umbilical Blood Sampling

Transabdominal needle into the uterus and the umbilical cord

Used to obtain fetal hematocrit in the case of Rh isoimmunization, other anemia and hydrops.

Also used for rapid karyotype analysis to asses fetal platelet count in alloimmune thrombocytopenia.

L/S ratio (lecithin to sphyngomyelin) predicts lung maturity.

Lecithin increases with age and sphyngomyelin decreases

L/S >2 is good. L/S<1.5 has a 70% chance of respiratory distress syndrome.

Other tests are measuring levels of posphatidylglycerol, saturated phosphatidyl choline, presence of lamellar bodies and surfactant to albumin ratio

NST- Non-stress test. 2 accelerations of heart rate 15 beats above baseline for 15 seconds is abnormal

OCT- Oxytocin challenge test/CST- Contraction stress test

BPP- Biophysical profiles- tests amniotic fluid volume, fetal tone, fetal activity, breathing movements, and  NST

Implantaion outside of the uterus

Low B-hCG

Treatment is surgery or methotrexate