D313 OB Maternity: Comprehensive Overview of Pregnancy & Labor

D313 OB Maternity: Comprehensive Overview of Pregnancy & Labor

D313 OB Maternity: Comprehensive Overview of Pregnancy & Labor

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Western Governors University

D313 Anatomy and Physiology II with Lab

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Prenatal Terms and Abbreviations

Pregnancy terminology is essential for accurate communication in obstetrics. Below are definitions of key prenatal terms:

• Preterm: Pregnancies that reach at least 20 weeks gestation but end before 37 completed weeks.
• Term: Pregnancy lasting between 37 and 42 weeks, subdivided into:
  • Early Term: 37 weeks to 38 weeks 6/7 days
  • Full Term: 39 weeks to 40 weeks 6/7 days
  • Late Term: 41 weeks to 41 weeks 6/7 days
• Postterm/Postdate: Pregnancy that extends beyond 42 weeks gestation.

Common Abbreviations in Prenatal Care

Abbreviation	Meaning
IUP/IUFD	Intrauterine Pregnancy / Intrauterine Fetal Demise
SAB	Spontaneous Abortion
TAB	Therapeutic Abortion
LMP	Last Menstrual Period
ROM	Rupture of Membranes
SROM	Spontaneous Rupture of Membranes
AROM	Artificial Rupture of Membranes
PROM	Prolonged Rupture of Membranes (>24 hours)
PPROM	Preterm Premature Rupture of Membranes
SVD	Spontaneous Vaginal Delivery
FHR	Fetal Heart Rate
EFM	Electronic Fetal Monitoring
US	Ultrasound Transducer (detects FHR)
FSE	Fetal Scalp Electrode (precise FHR reading)
IUPC	Intrauterine Pressure Catheter (measures contractions)
LTV	Long Term Variability
SVE	Sterile Vaginal Exam
MLE	Midline Episiotomy
NST	Non-Stress Test
CST	Contraction Stress Test
BPP	Biophysical Profile
VBAC	Vaginal Birth After Cesarean
AFI	Amniotic Fluid Index
BUFA	Baby Up For Adoption
NPNC	No Prenatal Care
PTL	Preterm Labor
BOA	Born On Arrival
BTL	Bilateral Tubal Ligation
D&C / D&E	Dilation & Curettage / Dilation & Evacuation
LPNC	Late Prenatal Care
TIUP	Term Intrauterine Pregnancy
VMI / VFI	Viable Male Infant / Viable Female Infant
EDB/EDC/EDD	Estimated Date of Birth / Confinement / Delivery

Obstetric Terminology: Gravidity, Parity, and Pregnancy Duration

What do Gravida and Para mean?

• Gravida (G): The total number of pregnancies a woman has had, including the current one, miscarriages, and abortions. Multiple pregnancies (twins, triplets) count as one.
• Parity (P): The number of pregnancies that have reached viability (20 weeks or more), regardless of whether the baby was born alive or stillborn.

Parity Term	Description	Number
Nullipara	No pregnancies beyond 20 weeks	0
Primipara	One pregnancy beyond 20 weeks	1
Multipara	Two or more pregnancies beyond 20 weeks	2+

What is GTPAL?

GTPAL is a system used to assess pregnancy outcomes by summarizing key reproductive history elements:

Letter	Meaning	Notes
G	Gravidity: Total pregnancies, including current, miscarriages, abortions	Twins/triplets count as one pregnancy
T	Term births: Number of births >37 weeks gestation	Includes live or stillborn births
P	Preterm births: Number of births between 20 and 36 6/7 weeks	Includes live or stillborn births
A	Abortions/miscarriages: Number of pregnancies ending before 20 weeks	Includes spontaneous and therapeutic abortions
L	Living children	Twins/triplets counted individually

Pregnancy Duration and Fetal Age

• Gestational age counts completed weeks from the first day of the last normal menstrual period (LMP), typically totaling 40 weeks.
• Fetal age is roughly two weeks less than gestational age, calculated from conception, averaging 38 weeks.
• Pregnancy is divided into three trimesters:
  • First trimester: 0 – 13 weeks
  • Second trimester: 14 – 26 weeks
  • Third trimester: 27 – 40 weeks

How to Use Naegele’s Rule for Estimating Delivery Date

Naegele’s Rule estimates the Expected Date of Delivery (EDD) based on the LMP:

1. Subtract 3 calendar months from the first day of the LMP.
2. Add 7 days.
3. Add 1 year.

For example:

Date Event	Date
Last menstrual period (LMP)	September 2, 2015
Minus 3 months	June 2, 2015
Add 7 days	June 9, 2015
Add 1 year	June 9, 2016

Practice Question 1

Scenario: A patient gave birth on her due date two hours ago. She has a three-year-old daughter born a week past her due date and a miscarriage at eight weeks last year.

How is this noted in GTPAL?

Option	G	T	P	A	L
A	2	2	1	0	2
B	3	2	1	0	1
C	3	2	1	0	2
D	3	2	0	1	2

Correct answer: D (3-2-0-1-2)

Practice Question 2

Scenario: A woman with three previous pregnancies, with children born at 39 weeks, twins at 34 weeks, and one at 38 weeks. She is currently 38 weeks pregnant.

What is her gravidity and parity?

Option	G	T	P	A	L
A	4	1	3	0	4
B	4	1	2	0	3
C	4	2	1	0	4
D	4	2	2	0	4

Correct answer: C (4-2-1-0-4)

Pregnancy Signs and Symptoms

Pregnancy signs are categorized into three types based on diagnostic certainty:

Presumptive Signs (Subjective)

• Absence of menstruation (amenorrhea)
• Fatigue and tiredness
• Enlarged and sore breasts
• Increased urination frequency
• Perceived fetal movement (quickening)
• Nausea and vomiting

Note: These signs are subjective and could be caused by other conditions; thus, they are not definitive for pregnancy.

Why is quickening not a positive sign?
Quickening can be mistaken for gastrointestinal movements such as gas, making it unreliable as a definitive pregnancy indicator.

Probable Signs (Objective)

• Positive pregnancy test detecting human chorionic gonadotropin (hCG)
• Ballottement (fetal rebound when uterus is tapped)
• Braxton Hicks contractions
• Goodell’s sign (softened cervix)
• Chadwick’s sign (bluish discoloration of vulva, vagina, cervix)
• Hegar’s sign (softening of lower uterine segment)
• Enlarged uterus

Note: These signs can be observed by healthcare providers but are not conclusive since some can be caused by other conditions.

Why is a positive pregnancy test not a positive sign?
Certain medical conditions and medications can cause elevated hCG levels, leading to false-positive results.

Positive Signs (Definitive)

• Fetal movement felt by examiner
• Detection of fetal heart tones by stethoscope or electronic monitoring
• Visualization of fetus by ultrasound
• Delivery of the baby

These signs confirm the presence of a living fetus.

What Should Be Avoided During Pregnancy?

Pregnant women should avoid:

• Teratogenic drugs such as thalidomide, certain anti-epileptics (valproic acid, phenytoin), retinoids (Vitamin A derivatives), ACE inhibitors, ARBs, lithium, warfarin, oral contraceptives, sulfonamides, and alcohol.
• TORCH infections (Toxoplasmosis, Parvovirus B19, Rubella, Cytomegalovirus, Herpes simplex virus), which are linked to fetal abnormalities.

Physiological Changes During Pregnancy

Pregnancy induces significant adaptations in various systems:

System	Changes/Effects
Pituitary	Changes in FSH/LH due to progesterone, increased prolactin, and oxytocin secretion.
Thyroid	Possible mild enlargement (goiter), increased metabolism and appetite.
Gastrointestinal	Pyrosis (heartburn), constipation, hemorrhoids due to progesterone-induced relaxation of smooth muscles.
Hematological	Increased plasma volume (up to 600 mg/dL), red blood cell volume increases but less so, causing physiological anemia. Pregnant women are hypercoagulable (increased risk of DVT).
Renal	Increased glomerular filtration rate, smooth muscle relaxation causes urinary urgency, frequency, nocturia, and edema.
Cardiovascular & Respiratory	Increased cardiac output; blood pressure remains stable or slightly decreases. Blood volume increases more than RBCs leading to dilutional anemia. Possible systolic murmurs. Mild respiratory alkalosis due to increased oxygen needs.
Musculoskeletal	Increased lordosis, low back pain, carpal tunnel syndrome, calf cramps due to shifting center of gravity and hormone effects.
Skin	Striae (stretch marks), chloasma (mask of pregnancy), linea nigra, Montgomery glands enlargement.

Hormones in Pregnancy

Hormone	Role in Pregnancy
Prolactin	Stimulates breast milk production
Estrogen	Supports growth of fetal organs and maternal tissues
Progesterone	Relaxes smooth muscles, maintains pregnancy
hCG	Maintains corpus luteum to prevent menstruation
Oxytocin	Stimulates uterine contractions during labor

Stages of Labor

Labor is divided into four stages:

Stage 1: Cervical Dilation

• Latent (early): Cervix dilates from 1 to 3 cm, mild contractions every 15-30 minutes.
• Active: Cervix dilates from 4 to 7 cm, moderate contractions every 3-5 minutes.
• Transition: Cervix dilates from 8 to 10 cm, strong contractions every 2-3 minutes.

Interventions: Provide comfort (ice chips, lip balm), monitor contractions and vitals, maintain privacy, encourage rest and breathing techniques, watch for signs of fetal descent.

Stage 2: Delivery of Baby

• Begins with full cervical dilation and ends with baby delivery.
• Includes monitoring for cord extension, blood loss, and uterine shape changes.

Stage 3: Delivery of Placenta

• Occurs 5-30 minutes after baby is born.
• Monitor mother’s vitals, inspect placenta (should have 2 arteries, 1 vein), and assess uterine firmness.
• Manage potential complications such as retained placenta or hemorrhage.

Stage 4: Recovery

• First 1-4 hours after placenta delivery.
• Monitor fundus, vitals, lochia discharge, and for signs of infection or hemorrhage.

True vs. False Labor

Feature	True Labor	False Labor
Cervical changes	Progressive dilation and effacement	No significant cervical changes
Contraction pattern	Regular, increasingly intense, closer together	Irregular, variable, no progression
Sensation location	Lower back radiating to abdomen	Usually abdominal or above umbilicus
Effect of movement	Intensifies with walking	Often decreases or stops with walking
Fetal engagement	Presenting part engaged in pelvis	Presenting part not engaged
Bloody show	Present	Absent

Fetal Heart Rate Patterns and Interpretation (VEAL CHOP)

Deceleration Type	Cause	Intervention	Interpretation
Variable Decelerations	Cord compression	Change maternal position, discontinue oxytocin, oxygen, amnioinfusion	Non-reassuring
Early Decelerations	Head compression	Monitor only	Normal (benign)
Late Decelerations	Uteroplacental insufficiency	Discontinue oxytocin, position change, oxygen, hydration, elevate legs	Non-reassuring

Hypertension in Pregnancy

Hypertension is defined as systolic >140 mmHg or diastolic >90 mmHg.

Signs and Symptoms

• Headache, right upper quadrant/epigastric pain
• Visual disturbances
• Reduced urine output
• Hyperreflexia
• Rapid weight gain

Risk Factors

• Previous preeclampsia
• Family history
• First pregnancy
• Obesity
• Age <18 or >35
• Chronic hypertension, diabetes, renal or autoimmune diseases

Complications

• Preeclampsia: Characterized by proteinuria, edema, and hypertension.
• HELLP Syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets; a severe variant.
• Eclampsia: Seizures or coma in pregnancy.

Treatment: Magnesium sulfate to prevent seizures, with calcium gluconate as the antidote for toxicity.

Factors Affecting Labor: The 5 P’s

Factor	Description
Passenger	The fetus and placenta; size, presentation, lie, attitude
Passageway	The birth canal: pelvis and soft tissues
Powers	Uterine contractions and maternal pushing
Position	Maternal posture during labor
Psychology	Maternal mental state and emotional response

Fetal Position and Presentation

• Presentation: Part of fetus entering pelvis first:
  • Cephalic (head first)
  • Breech (buttocks/feet first)
  • Shoulder
• Lie: Orientation of fetal spine relative to mother’s spine:
  • Longitudinal (parallel) – most favorable for vaginal birth
  • Transverse or oblique – vaginal birth usually not possible.

References

American College of Obstetricians and Gynecologists. (2020). Practice Bulletin No. 217: Prelabor Rupture of Membranes. Obstetrics & Gynecology, 135(3), e90-e102.

Elsevier. (2023). Maternity and Pediatric Nursing (Latest Edition).

D313 OB Maternity: Comprehensive Overview of Pregnancy & Labor

Stanford Children’s Health. (2024). Pregnancy & Childbirth Overview. Retrieved from https://www.stanfordchildrens.org/en/topic/default?id=pregnancy-and-childbirth-90-P02590Search

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