[NCLEX] Antepartum 1(Fetal circulatory system, Physiogical changes in pregnancy)

✔ Fetal circulatory system

• From placenta to Umbilical vein(O2 rich blood)
• ductus venosus (정맥관) → bypass the liver → right side of heart
• The foramen ovale : allows to go from right to left atrium(우심방->좌심장)
• Then to the left ventricle and out the aorta . As a result the blood with the most O2 gets to the brain.

[ key point : 폐가 아닌 태반!! ]

• 아기 필수 순환구조 : foramen ovale / ductus arteriosus
• Fetal HR : 110-160bpm/min (bpm: beat per mintue)

✔ Physiogical changes in pregnancy

• Body image changes
  • 신체/정신적 변화 -> 가족 구성원이 지지!
  • First trimester (1-13wks) : Not obvious 큰 변화 없음.
  • Second trimester (14-26wks) : rapid changes
  • third trimester (27-40wks) : emotion (resentment/분함-임신으로 인해, anxiousness/불안감-다가오는 임신으로 인해)
• signs of pregnancy
  • Presumptve signs(추정징후)
    • Amenorrhea (progesterone)
    • Fatigue
    • N/V
    • Urinary frequency
    • Breast changes (tenderness)
    • Quickening(보통 16-20wks)
    • Uterine enlargement(자궁증대)
  • Probable signs(가정 징후)
    • Abdominal enlargement
    • Hegar’s sign: 자궁하부가 부드러워지는 현상
    • Chadwick’s sign : 자궁경부 점막이 보랏빛(청)으로 변하는 현상
    • Goodell’s sign : 자궁경부 끝이 부드러워지는 현상
    • Positive pregnancy test : hcg(pos)
    • Braxton Hicks contractions: (불규칙, 무통성)의 가진통. 걸으면 완화
  • Positive signs(확정징후) - 보통 엔클에서 확정징후를 찾으라는 문제로 많이 나옴!!
    • Fetal heart sounds
    • Visualization of fetus by ultrasound
    • Fetal movement palpated by an experienced examiner
• ✨Calculating EDD and determining number of pregnancies
  1. Nagele’s rule : -3M+7D+1Y
  2. Gravidity(임신 횟수) : number of pregnancies
  • Nulligravida : never been pregnant (G=0)
  • Primigravida : first pregnant
  • Multigravida : has had two or more pregnancies
  1. parity(출산 횟수) : number of births (reach 20 wks of pregnancy : 20주이상만 포함.) , not the number of fetuses.(태아 수는 포함X)
  2. GTPAL : Gravidity(임신 횟수) / Term birth(37wks 이상 - 만삭) / Preterm birth(37wks 미만- 조산) / Abortions(20wks 미만 - 유산) / Living children(생존자녀수)
• Skin changes
  • Chloasma: pigmentation on the face
  • Linea nigra : dark line of pigmentation from the umbilicus to the pubic area
  • Striae gravidarum : stretch marks (mostly on the abdomen and thighs)
  • Increasing the areolas darkening 유륜의 색 진해짐.

• V/S
  • In the supine position -> risk of maternal BP↓ and fetal hypoxia
  💡 why? pressure of the gravid uterus on the vena cava, venous blood flow to the heart. (하대 정맥 압박으로 혈류량 감소)
  • dizzy / lightheadedness / pallor / clammy skin
  • positioning on the left lateral side