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Prenatal Week 1 assignment: Signs and Symptoms of Pregnancy / Calculating the Correct DatePart 11. What does the term “presumptive sign of pregnancy” mean? Refers to possibility of pregnancy. Subjective signs of pregnancy.2. What does the term “probable sign of pregnancy” mean? Refers to most likelihood of indicating pregnancy. Objective signs of pregnancy and include all physiological and anatomical changes that can be perceived by the healthcare provider3. What does the term “positive sign of pregnancy” mean? Refers to confirmation of pregnancy. Objective signs of pregnancy that can only be attributed to the fetus4. What are the presumptive signs of pregnancy? Amenorrhea (no period), Nausea — with or without vomiting, breast enlargement and tenderness, fatigue, poor sleep, back pain, constipation, food cravings and aversions, mood changes or "mood swings,” heartburn, nasal congestion, shortness of breath, lightheadedness, elevated basal body temperature (BBT), spider veins, reddening of the palms, quickening, positive pregnancy tests.5. What are the probable signs of pregnancy? Increased frequency of urination, Goodell’s sign (Softening of the cervix and vagina with increased leukorrheal discharge; palpated at 8 weeks), Chadwick’s sign (bluish-purple coloration of the vaginal mucosa, cervix and vulva seen at 6-8 weeks), Hegar's Sign (softening of the lower uterine segment; palpated at 6 weeks), Melasma/ chloasma (also referred to as the mask of pregnancy; brownish pigmentation over the forehead, temples, cheek, and/or upper lip), Linea nigra (dark line that runs from the umbilicus to the pubis), abdominal bloating/enlargement, mild uterine cramping/discomfort without bleeding, nipples and areola become darker, ballottement (a light tap of the examining finger on the cervix causes fetus to rise in the amniotic fluid and then rebound to its original position; occurs at 16-18 weeks).6. What are the positive signs of pregnancy? Auscultation of the fetal heart, by 10-12 weeks with a Doppler, visualization of fetus (ultrasound), observation and palpation of fetal movement by the examiner after about 20 weeks.7. Why might a woman not want to disclose whether she has had a previous pregnancy or not? There are many reasons why a woman might want to keep a previous pregnancy secret, including if she was a sexual assault or ritual victim, resulting in pregnancy, whether she gave the baby up for adoption or had an abortion; had an elective abortion; to secure a job: some of the terms of getting a job might include not having a family; might make dating difficult: single mothers prefer to omit their motherhood status, especially in their initial dating stages for fear of putting off the man; hide a child with special needs or disabilities; cultural stigma.8. List four exams that can be done to help determine a previous pregnancy. For each list what you are looking for and the differences between a woman that is pregnant for the first time and one that has had a previous pregnancy.a. Vaginal changes such as: vaginal stretching- Primigravida: vaginal muscle tone still good/firm. Multigravida: the vagina will feel much looser, softer and wider than before pregnancy; it might take a few months before it starts to feel anywhere as snug again. Vaginal dryness- is linked to lower levels of estrogen in the body. If breastfeeding, have even less estrogen in the body. Might need to use water based lubricant during sexual intercourse. Vaginal soreness- increased lower vaginal pressure.b. Changes in Breast Size & Shape: the size and shape of the breasts grow more than once during pregnancy and childbirth, due to the effects of increased levels of progesterone and estrogen. During breastfeeding, the breastmilk affects the density of fatty tissues, which determines the size of the breasts yet again, resulting in an even larger cup, while others shrink or sag. As the milk starts to flow in, it causes the skin and tissue in the area to stretch. With each subsequent birth, hormones fluctuate and skin stretches. Primigravida: firm, nipples do not project excessively. Multigravida: the breasts may never fully reduce back to their pre-baby firmness; may sag more, nipples more pronounced if breastfeeding, hyperpigmentation of areola.c. Stretch Marks: take place when the collagen and elastin in the skin stretch to the point of no bouncing back. Highly influenced by genetics and may never go away. Primigravida: new ones are pinkish or light brown in darker skinned women. Multigravida: old ones are silvery white or darker brown in darker skinned women.d. Changes in Feet & Hand Size: the changes in the woman’s hormone levels cause muscles and ligaments to become more relaxed in order to prepare for labor. This destabilizes the pelvis, resulting in inflammation in the lower extremities, and these changes continue after childbirth. Primigravida: no discernable changes. Multigravida: may cause shoe size change of up to a whole size; could develop carpal tunnel syndrome, a loss of sensation in the hands caused by pressure on the median nerve in the wrist. Part 21. Why are due dates only estimates and not “exact science”? The reason why a pregnant woman's due date calculation is more of an estimated guess, rather than a real calculation is because due date calculations are based on standards and averages. Due date calculations are made using the woman’s LMP or the last menstrual cycle before pregnancy begins. This can pose a problem because women can have irregular menstrual cycles, or cycles that are not 28 days; they may be uncertain about the date of their LMP; many people do not ovulate on the 14th day of their cycle; the embryo may take longer to implant in the uterus. Another thing that can greatly affect the LMP--and thus the due date--is consuming contraceptive pills (birth control), since birth control can mess with the length of a cycle and when the hormone levels in the body return back to normal this can also greatly affect the due date. Research indicates that some people are more likely to recall a date that includes the number 5, or even numbers, so they may inaccurately recall that the first day of their LMP has one of these numbers in it. If the pregnancy is advanced, in late 2nd or 3rd trimesters.2. What is a gestation wheel? Explain how it work? Also known as the pregnancy wheel or “wheel of fortune.” Used to determine a baby’s due date. Consists of two circular pieces of cardboard attached by a brad. The months and days of the year are on the outer wheel to calculate due dates.?Plus, information on fertility, screenings, and your baby’s size are on the inner wheelLike most due date calculators, a pregnancy wheel uses the woman’s last menstrual period as a benchmark. It is an incredibly simple tool to track the pregnancy and baby’s progress. Here’s how to use it: find the arrow labeled “first day of last period” on the inner wheel and move it to point to that date. Now all of the other important dates in pregnancy, from conception to hearing the baby’s heartbeat, to the due date, will align with the appropriate dates.3. Some people use what is known as “lunar reckoning”. What is this and how does it work? Somewhere it states that pregnancy lasts for 10 lunar months or 10 times 28 days, the time it takes for the moon to go from full moon to full moon is one full cycle. The issue is that most people have taken one of these cycles to be the same as the average ovulation cycle of 4 weeks or 28 days; 10 times 28 days is 280 days which is how long pregnancy is said to last on average. The problem here is that a lunar cycle does not last 28 days, it actually lasts roughly 29.3 days, meaning that if you use the lunar cycles to calculate the due date of a baby, then 10 lunar months or cycles would actually equal roughly 295 days. 4. What is Naegele’s rule? How does it work? Explain how you would calculate a due date using this. Naegele's rule is a standard way of calculating the due date for a pregnancy when assuming a gestational age of 280 days at childbirth. It assumes that the woman had a 28-day menstrual cycle, and that she ovulated exactly on the 14th day of her cycle. The defects in calculation of the EDD by Naegele’s rule is related to the afore mentioned facts, with expectation that ovulation occurs on the fourteenth day of the cycle and conception occurs usually around the day of ovulation (+48 hrs) in 95% of the cases. Moreover, the discrepancies caused by 31 day-months and the 29 day variation in February of leap years are not correctable by Naegele’s rule To calculate the EDD according to Naegele’s rule, add 7 days to the first day of the last period, and then count backwards 3 months, add 1 year. This is equal to counting forward 280 days from the date of the last period. For example: LMP = April 4 2020LMP = April 4, 2020+ 1 year = April 4, 2021+ 7 days = April 11, 20203 months = January 4, 2021- 3months = January 11, 2020+ 7 days = January 11, 2021+ 1 year = January 11, 20215. What is a modified Naegele’s rule? Why would you use this? The suggestive modified Naegele’s rule should be: the first day of LMP + 7 days + 9 months +/- correction value (adding or subtracting the number of days exceeding or receding from the classic 28 days cycle). Accordingly, increase or decrease in the length of the cycle will give a false shortening or lengthening of the conception delivery interval, as the variability mostly affects the follicular phase of the cycle, a correct date for delivery may be obtained by Naegele’s rule, if the increase or decrease in this follicular phase is considered properly. In other words, a short cycle needs subtraction of correction factor and vice versa. This modified rule was proved to be accurate in determining the EDD in all cases it was applied to, irrespective of the length of the cycle. Example: if a woman’s cycle is 30 days, LMP + 9 months + 7 days + 2 days if a woman’s cycle is 26 days, LMP + 9 months + 7 days – 2 days 6. What is Wood’s method? Explain how it works. Wood’s method, also called Nichols’ rule, was developed by midwifery professor Carol Wood Nichols. This calculation method is based on an estimated due date of 41 weeks, two days for first babies and 40 weeks, five days for babies after your first. Unlike Naegele’s rule, it can be modified to take into account cycles that are longer or shorter than 28 days. To use Wood’s method:Add 12 months to the first date of the last period.For primips: Subtract two months and 14 days.For multips: Subtract two months and 18 days.The answer is the EDD if you have 28-day cycles. ?If your cycles are longer than 28 daysSubtract 28 from 31: The discrepancy between the average cycle and your cycle is 3. Add three days to the estimated due date,.If your cycle is shorter than 28 days, subtract the number of days from 28, then subtract that number from the due date you calculated using Wood’s method.Example: Primigravida with 28 day cycle: LMP June 16, 2020 + 12 months (June 16, 2021) – 2 months (April 15, 2021) -14 days (April 1, 2021) = EDD: April 1, 2021,Multipara EDD: March 28, 2021 (subtracting an additional 4 days)7. Give reasons why you might prefer Naegele’s rule (including modified) over Wood’s method. If you would not prefer it, why not? I prefer the modified Naegele’s method because it has proven to be more accurate and it takes into account the different menstrual cycle lengths. It is also easy to calculate. 8. Some midwives prefer to use a method known as “Simple addition of days”. What is this and how does it work? Give an example. This method of determining EDD involves simply adding 266 days from known conception. Seems to be more useful in women tracking their cycles using the rhyme method of conception or undergoing fertility treatment when time of fertilization is known. Example: if a woman’s date of conception is November 11, 2020, her EDD will be August 4, 2021 9. What was Mittendorf’s study? Give an example of how this could be used in reality.Mittendorf’s study found that uncomplicated, spontaneous-labor pregnancy in private-care white mothers is longer than Naegele's rule predicts. For primiparas, the median duration of gestation from assumed ovulation to delivery was 274 days (or 288 from LMP to delivery), significantly longer than the predicted 266 days, and for multiparas, the median duration of pregnancy was 269 days (or 283 from LMP to delivery), also significantly longer than the prediction. The study suggests that when estimating a due date for private-care white patients, one should count back 3 months from the first day of the last menses, then add 15 days for primiparas or 10 days for multiparas, instead of using the common algorithm for Naegele's rule.Example: Primiparas: LMP - 3 months + 15 days (+ or - days more or less than 28) Cycle 30 days 10/10/20 – 3 months + 15 days + 2 days EDD = 07/27/2021 Multiparas: LMP - 3 months + 10 days (+ or - days more or less than 28) Cycle 27 days 10/10/20 – 3 months + 10 days -1 day EDD = 07/21/202110. How does race and genetic difference play a role in estimating due date? Normal gestational length is shorter in Black and Asian women compared with white European women and fetal maturation may occur earlier. The median gestational age at delivery was 39 weeks in Blacks and Asians and 40 weeks in white Europeans. Others factors than may influence gestation length variations include height and to a lesser extent, dietary and environmental factors.11. What role do ultrasounds play in estimating due date? If a patient cannot accurately recall the first the day of her last menstrual period, has irregular cycles, or Naegele’s rule cannot be used, the next step is ultrasonography. Ultrasonography is best within the first half of the pregnancy.?Transvaginal (TV) sonogram can identify?an intrauterine pregnancy (IUP)?approximately 4 weeks after the LMP. An embryo is usually seen later between 5-6 weeks. Margin of error per trimester: 1st trimester: +/- 5 days 2nd trimester: +/- 8 days 3rd trimester: +/- 3 weeks12. How can the menstrual cycle of a woman make EDD calculation complicated?Unless the woman went the IVF route, pregnancy math can be a little murky. Knowing the exact time of conception is near impossible. It can be pretty difficult to determine a due date using the LMP method for women with irregular cycles — which is why an ultrasound exam is often required to determine gestational age. (An early ultrasound, usually done at about 6 to 9 weeks, can give the most accurate due date estimation by measuring the size of the embryo or fetus.). However, many pregnancies are confirmed by a Doppler heartbeat monitor, not an ultrasound. As the pregnancy progresses, fundal measurement — the distance from the top of the pubic bone to the top of the uterus can be used to help date and evaluate fetal wellbeing. The length of this is approximately the size of your uterus and closely correlates to how far along the pregnancy is.13. After reading how the due date plays a role in Western society, write a short 250 word essay on how the due date plays a role in the developing world. You may use outside resources if you choose, but make sure you include the source in a citation if you do. Like in any developed country, many women in developing countries are excited to discover they are pregnant and can obsess about the process. However, for a majority of the female population, a woman’s pregnancy and due date can be a death sentence. Maternal mortality is much higher in developing countries compared to developed nations owing to lack of adequate medical care; high prevalence of infectious diseases, higher total fertility rate and due to health care system difference (1). Unintended and unwanted pregnancies – owing to unmet need for contraception, to contraceptive failure, or to unwanted sex – if brought to term, carry at least the same risks as those that are desired and deliberate (2). In these countries, most poor women deliver at home. This suggests that, at least in the near term, efforts to reduce maternal deaths should prioritize community-based interventions aimed at making home births safer. More than 70% of all maternal deaths are due to hemorrhage, infection, unsafe abortion, hypertensive disorders of pregnancy, and obstructed labor and the underlying causes for these deaths are poverty, inadequate, inaccessible, or unaffordable health care, unequal access to resources, low status of women and illiteracy (1).As the woman’s due date approaches, she is faced with financial demands that need to be addressed or cannot be met. For the poorest women cost and or lack of access are the predominant reasons for not delivering in a facility. Many women are forced to resort to unattended home births.1. Matern Health Neonatol Perinatol. 2017; 3: 19. Published online 2017 Nov 7. doi:?10.1186/s40748-017-0059-8Correlates of maternal mortality in developing countries: an ecological study in 82 countries2. WHO” The world health report: Not Every Pregnancy is Welcome ................
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