🔶PREGNANCY
FINAL EXAM STUDY GUIDE
TOPIC 1 — FOUNDATIONS OF
Chapters This Topic Comes From:
Chapter 12 – Nursing Management During Pregnancy
OB Material 1st Day of Class
Chapter 11 – Maternal Adaptation (physiologic signs)
ATI Maternal Newborn (Ed.12.0) (reference integrated but no citation required)
1. DEFINITION
Early foundational concepts in pregnancy include diagnostic signs, dating
methods, gravida/para classification, fundal height growth patterns, safe
vaccines, positional complications, and danger signs requiring urgent evaluation.
2. PATHOPHYSIOLOGY (WHY IT
HAPPENS)
hCG production by the trophoblast stimulates many early symptoms and allows
pregnancy tests to be positive.
Estrogen & progesterone rise → breast changes, amenorrhea, fatigue, NV.
Uterine growth stretches ligaments, increases blood volume, pushes on bladder →
urinary frequency & fundal height changes.
Gravid uterus compresses the inferior vena cava when supine → ↓ venous return
→ supine hypotensive syndrome.
Placental development & maternal immune modulation determine which vaccines are
safe or contraindicated.
3. CLINICAL MANIFESTATIONS
Signs of Pregnancy
,Presumptive (subjective; woman feels it)
Amenorrhea, fatigue, NV, breast tenderness, quickening, urinary frequency.
Not diagnostic because these may have other causes.
Probable (objective; observed by examiner)
Goodell sign—softening of cervix
Chadwick sign—bluish cervix
Hegar sign—softening of uterine isthmus
Positive urine/serum hCG
Enlarged abdomen
Positive (definitive fetal evidence)
Ultrasound showing fetal parts
Fetal heart rate (Doppler)
Fetal movement palpated by provider
Fundal Height Expectations
12 weeks → above symphysis pubis
20 weeks → at the umbilicus
20–36 weeks → cm ≈ gestational age
Deviations → IUGR, oligohydramnios, polyhydramnios
Supine Hypotensive Syndrome
Dizziness, pallor, tachycardia when lying flat from vena cava compression.
Danger Signs
Vaginal bleeding, severe abdominal pain, persistent vomiting, severe headache, blurred
vision, facial/hand edema, decreased fetal movement, rupture of membranes.
4. RISK FACTORS
Previous pregnancy complications
Advanced maternal age or adolescence
Chronic diseases (HTN, DM)
Multiple gestation
History of miscarriage
Placental issues (previa risk increased with prior C-section)
,5. LABS & DIAGNOSTICS
Pregnancy Test
hCG in urine/serum.
Low levels → possible ectopic or miscarriage.
Very high → molar pregnancy concern.
EDD (Estimated Date of Delivery) – Naegele’s Rule
LMP – 3 months + 7 days.
Fundal Height (Normal Ranges)
Height in cm ≈ gestational age (20–36 wks).
2 cm difference → abnormal growth pattern → requires ultrasound confirmation.
6. TREATMENTS & MEDICAL
MANAGEMENT
Vaccines in Pregnancy
Safe:
Tdap (27–36 weeks)
Inactivated influenza
Hepatitis B
Contraindicated:
MMR
Varicella
Live attenuated influenza spray
(Live vaccines risk fetal transmission.)
Supine Hypotensive Syndrome
Turn to left lateral position → restores venous return & increases CO.
, 7. WHAT TO MONITOR /
COMPLICATIONS
Heavy bleeding → miscarriage, previa, abruption.
Severe NV → dehydration & electrolyte imbalance.
Headache + vision changes → preeclampsia.
Decreased fetal movement → fetal hypoxia or demise.
Fundal height abnormalities → IUGR or polyhydramnios.
8. NURSING INTERVENTIONS
Teach pregnancy signs and when to call provider.
Positioning education: avoid supine after 20 weeks.
Routine fundal height measurement each visit.
Vaccination education (safe vs unsafe).
Reinforce prenatal visit schedule.
Teach normal discomforts vs danger signs.
9. ASSESSMENT
LMP, cycle regularity, GTPAL classification, obstetric history.
Baseline vitals, weight, labs (CBC, blood type, antibody screen).
Screen for danger signs & psychosocial stressors.
Assess hydration & NV severity.
10. PLANNING / GOALS
Early, accurate pregnancy confirmation.
Prevent maternal hypotension.
Prevent complications by recognizing danger signs early.
Ensure vaccination safety.
Maintain healthy fetal growth.
FINAL EXAM STUDY GUIDE
TOPIC 1 — FOUNDATIONS OF
Chapters This Topic Comes From:
Chapter 12 – Nursing Management During Pregnancy
OB Material 1st Day of Class
Chapter 11 – Maternal Adaptation (physiologic signs)
ATI Maternal Newborn (Ed.12.0) (reference integrated but no citation required)
1. DEFINITION
Early foundational concepts in pregnancy include diagnostic signs, dating
methods, gravida/para classification, fundal height growth patterns, safe
vaccines, positional complications, and danger signs requiring urgent evaluation.
2. PATHOPHYSIOLOGY (WHY IT
HAPPENS)
hCG production by the trophoblast stimulates many early symptoms and allows
pregnancy tests to be positive.
Estrogen & progesterone rise → breast changes, amenorrhea, fatigue, NV.
Uterine growth stretches ligaments, increases blood volume, pushes on bladder →
urinary frequency & fundal height changes.
Gravid uterus compresses the inferior vena cava when supine → ↓ venous return
→ supine hypotensive syndrome.
Placental development & maternal immune modulation determine which vaccines are
safe or contraindicated.
3. CLINICAL MANIFESTATIONS
Signs of Pregnancy
,Presumptive (subjective; woman feels it)
Amenorrhea, fatigue, NV, breast tenderness, quickening, urinary frequency.
Not diagnostic because these may have other causes.
Probable (objective; observed by examiner)
Goodell sign—softening of cervix
Chadwick sign—bluish cervix
Hegar sign—softening of uterine isthmus
Positive urine/serum hCG
Enlarged abdomen
Positive (definitive fetal evidence)
Ultrasound showing fetal parts
Fetal heart rate (Doppler)
Fetal movement palpated by provider
Fundal Height Expectations
12 weeks → above symphysis pubis
20 weeks → at the umbilicus
20–36 weeks → cm ≈ gestational age
Deviations → IUGR, oligohydramnios, polyhydramnios
Supine Hypotensive Syndrome
Dizziness, pallor, tachycardia when lying flat from vena cava compression.
Danger Signs
Vaginal bleeding, severe abdominal pain, persistent vomiting, severe headache, blurred
vision, facial/hand edema, decreased fetal movement, rupture of membranes.
4. RISK FACTORS
Previous pregnancy complications
Advanced maternal age or adolescence
Chronic diseases (HTN, DM)
Multiple gestation
History of miscarriage
Placental issues (previa risk increased with prior C-section)
,5. LABS & DIAGNOSTICS
Pregnancy Test
hCG in urine/serum.
Low levels → possible ectopic or miscarriage.
Very high → molar pregnancy concern.
EDD (Estimated Date of Delivery) – Naegele’s Rule
LMP – 3 months + 7 days.
Fundal Height (Normal Ranges)
Height in cm ≈ gestational age (20–36 wks).
2 cm difference → abnormal growth pattern → requires ultrasound confirmation.
6. TREATMENTS & MEDICAL
MANAGEMENT
Vaccines in Pregnancy
Safe:
Tdap (27–36 weeks)
Inactivated influenza
Hepatitis B
Contraindicated:
MMR
Varicella
Live attenuated influenza spray
(Live vaccines risk fetal transmission.)
Supine Hypotensive Syndrome
Turn to left lateral position → restores venous return & increases CO.
, 7. WHAT TO MONITOR /
COMPLICATIONS
Heavy bleeding → miscarriage, previa, abruption.
Severe NV → dehydration & electrolyte imbalance.
Headache + vision changes → preeclampsia.
Decreased fetal movement → fetal hypoxia or demise.
Fundal height abnormalities → IUGR or polyhydramnios.
8. NURSING INTERVENTIONS
Teach pregnancy signs and when to call provider.
Positioning education: avoid supine after 20 weeks.
Routine fundal height measurement each visit.
Vaccination education (safe vs unsafe).
Reinforce prenatal visit schedule.
Teach normal discomforts vs danger signs.
9. ASSESSMENT
LMP, cycle regularity, GTPAL classification, obstetric history.
Baseline vitals, weight, labs (CBC, blood type, antibody screen).
Screen for danger signs & psychosocial stressors.
Assess hydration & NV severity.
10. PLANNING / GOALS
Early, accurate pregnancy confirmation.
Prevent maternal hypotension.
Prevent complications by recognizing danger signs early.
Ensure vaccination safety.
Maintain healthy fetal growth.
