First day of last menstrual period, subtract 3 months, and add 7 days

* most accurate when woman remembers last menstural period, has menses every 28 days, and was not taking oral contrceptives

Uses uterine size to inidcate gestational age by measuring, in centimeters, distance from symphysis pubis to top of uterine fundus

* Fundal height  

distance in centimeters X 8 = total wks gestation

                             7

8 weeks' gestation; ultrasonic Doppler device

* More commonly heard between 10-12 weeks

The number of infants delivered after 20 weeks gestation, born dead or alive

* multiple births count as one delivery regardless of # of infants delivered

• T: term infants born after 37 weeks
• P: preterm infants born btw 20 and 37 weeks
• A: abortion prior to 20 wks (spontaneous or therapeutic)
• L: living children

subjective S&Sx that woman reports

• amenorrhea
• N&V
• fatigue
• urinary frequency
• breast changes
• quickening

Objective S&Sx noted by examiner

• Hegar's Sign
• McDonald's sign
• Enlargement of abdomen
• Pigmentation changes
• Ballottement
• + pregnancy test
• palpation of fetal outline

Diagnostic S&Sx noted by examiner

• Fetal heart beat
• fetal movement palpable by examiner
• visualization of fetus by US

• CBC
• Blood Group and Rh typing
• Urinalysis
• TORCH
• STIs

• RBC count (normal 4.2-5.4) 5-6.25 million/mm3
• Hgb (normal 12-16) >11 g/dL
• hct (normal 37-47%) >33%
• WBC count (normal 5-10,000) 5-15,000/mm3
• Polymorphonuclear cells (normal 55-70% of WBCs) 60-85% of WBCs)
• Lymphocytes (normal 20-40% of WBCs) 15-40% of WBCs
• Platelet count (normal 150,000-400,000/mm3) no change until 3-5 days postpartum

• T: toxoplasmosis
• O: other (usually hepatitis)
• R: rubella
• C: cytomegalovirus
• H: hsv

Serologic testing: indirect fluorescent antibody test

• IgG titers greater than 1:256 suggest recent infection
• IgM titers greater than 1:256 indicate acute infection

• miscarriage in early pregnancy
• CNS lesions in neonate that can result in:

                     * hydrocephaly

                     * microcephaly

                     * chronic retinitis

                     * seizures

• fever
• malaise
• nausea
• abdominal discomfort

*may be associated with liver failure

• preterm birth
• hepatitis infection
• intrauterine fetal death

• IgG antibodies to rubella measured
• titer of 1:10 or > indicates maternal immunity
• titer of 1:8 or < indicates minimal or no immunity

• fever
• rash
• mild lymphedema

• miscarriage
• congential anomalies
• death

Exposure to CMV via respiratory droplet, semen, cervical and vaginal secretions, breast milk, placental tissue, urine, feces, and banked blood

*most common method is via respiratory droplet

• viral culture (most definitive)
• CMV antibodies indicate recent infection
• fourfold increase in CMV titer in paired sera drawn 10-14 days apart is usually indicative of an acute infection

• asymptomatic illness
• cervial discharge
• mononucleosis-like syndrome

• fetal death
• hemolytic anemia and jaundice
• hydrocephaly or microcephaly
• pneumonititis
• hepatosplenomegaly
• deafness

• blisters
• rash
• fever
• malaise
• nausea
• h/a

• miscarriage
• preterm labor
• stillbirth
• transplacental infection (rare) causing skin lesions, IUGR, mental retardation, and microcephaly

• genital lesions
• chronic vaginal discharge
• pruritis
• cervical dysplasia
• some strains are asymptomatic

* symptoms depend on viral strain causing infection

Juvenile Laryngeal Papillomata

• reactive enzyme immunoassay (EIA)
• + Western blot
• immunofluorescence assay
• p24 antigen capture assay (as early as 2-6 weeks)
• Viral cultures

• opportunistic diseases
• fever
• h/a
• night sweats
• malaise
• generalized lymphadenopathy
• myalgias
• Nausea
• diarrhea
• weight loss
• sore throat
• rash

• asymptomatic at birth
• opportunistic infections
• immunodeficiency
• failure to thrive
• parotitis
• lymphadenopathy
• hepatosplenomegaly
• fever
• chronic diarrhea
• dermatitis
• thrush
• death

• can dx neonatal HIV as early as 2-6 weeks after infection
• detects HIV before seroconversion
• Determines progression of AIDS

• preterm labor
• chorioamnionitis
• PROM
• UTI
• postpartum infections

• neonatal meningitis
• sepsis
• septic shock
• early onset GBS has significant infant mortality rate

• microscopic exam of primary & secondary lesion tissue
• serology used during latency and late infectioin
• screening at first prenatal visit and again late in 3rd trimester with VDRL (venereal disease research lab) or RPR (rapid plasma reagin) test
• If either VDRL or RPR positive, dx is confirmed by fluorescent treponemal antibody absorption (FTA-ABS) test

• chancre develops on skin near infection during acute stage
• lymphadenopathy and rash on palms of hands and soles of feet during 2nd stage
• asymptomatic during latent stage, lasts up to 5 yrs
• CNS, Cardiovascular, ocular S&Sx involved in tertiary stage
• miscarriage or premature labor

• CNS damage
• hearing loss
• death

• screened at initial prenatal visit and at-risk women should be screened again at 36 wks gestaton
• Thayer-Martin culture of endocervix, rectum, or pharynx

• purulent endocervical discharge
• menstrual irregularities
• pelvic or lower abdominal pain
• PROM
• sometimes asymptomatic

• preterm birth
• neonatal sepsis
• IUGR
• ophthalmia neonatorum, which can result in blindness

• bleeding
• mucoid or purulent cervial discharge
• PID
• dysuria
• usually asymptomatic

• conjunctivitis
• pneumonia
• ophthalmia neonatorum, which can result in blindness

• Every 4 wks during first 28 weeks' gestation
• Every 2 wks until 36 weeks' gestation
• Every wk until delivery

• neural tube defects
• other body wall defects
• threatened abortion
• fetal distress
• death

• trisomy 21 (down syndrome)
• fetal wastage

• Explain test to client
• 50-g oral glucose load administered
• venous plasma glucose is assessed 1 hr later

• Fasting: >105 mg/dL
• 1 hour: > 190 mg/dL
• 2 hour: > 165 mg/dL
• 3 hour: > 145 mg/dL

• 10-13 Ibs in first 20 wks
• about 1 Ib per wk after 20th week
• total weight gain of 25-35 Ibs

• fetus, placenta, amniotic fluid (11 Ibs)
• uterus (2 Ibs)
• blood volume increase (4 Ibs)
• Breast tissue (3 Ibs)
• maternal stores (5-10 Ibs)

• total blood volume increase of 45%
• RBCs increase 18-30%
• Plasma volume increases 50%
• The greater increase in plasma over RBCs results in physiologic anemia and is seen in a 7% decrease in hematocrit

• relaxed smooth muscles
• decreased peristalsis (bloating)
• reflux of gastric secretions
• constipation

* GI problems worsened as gravid uterus presses on intestines

• urinary frequency (1st & 3rd trimesters)
• glomerular filtration increases 50% (2nd trimester until delivery)
• glycosuria because kidneys cannot reabsorb all glucose filtered

• secreted by trophoblast early in pregnancy
• stimulates progesterone and estrogen production
• thought to support pregnancy
• causes n&v in 1st trimester

• estrogen and progesterone produced by corpus luteum for 7 wks of pregnancy and then by placenta
• estrogen stimulates uterine development to support fetal growth and stimulates ductal system of breast for lactation
• progesterone maintains endometrium, decreases uterine contractility, stimulates development of breast acini and lobules, and causes relaxation of smooth muscle