Title OB NURSING PERSONAL NOTES (@PNLEPREP) ✅

Hormonal Changes in the Ovarian and Endometrial Cycles Ovarian Cycle: 1. Follicular Phase (Days 1-14) ○ Hormones Involved: ■ FSH (Follicle-Stimulating Hormone): Rises to stimulate the growth of 6-12 graafian follicles. ■ LH (Luteinizing Hormone): Increases slightly alongside FSH. ■ Estrogen: Secreted by growing follicles, peaks as the dominant follicle matures. High estrogen levels suppress FSH secretion to prevent further follicle maturation. ■ Progesterone: Low at the beginning of this phase. 2. Ovulatory Phase (Around Day 14) ○ Hormones Involved: ■ LH: Surge in LH levels triggers ovulation and final follicular maturation. ■ FSH: Increases but to a lesser extent compared to LH. ■ Estrogen: Decreases slightly before ovulation. ■ Progesterone: Begins to rise just before ovulation to prepare the endometrium. 3. Luteal Phase (Days 15-28) ○ Hormones Involved: ■ LH: Maintains corpus luteum formation. ■ FSH: Decreases due to elevated levels of estrogen and progesterone. ■ Estrogen: Remains high initially but will decline if pregnancy does not occur. ■ Progesterone: Peaks as corpus luteum secretes large amounts to support endometrial thickening. Endometrial Cycle: 1. Proliferative Phase (Days 1-14) ○ Hormones Involved: ■ Estrogen: Promotes growth of endometrial cells, thickening of the endometrial lining, and elongation of blood vessels. 2. Secretory Phase (Days 15-28) ○ Hormones Involved: ■ Estrogen and Progesterone: Continue to thicken the endometrial lining, with progesterone increasing secretion of nutrients to support a potential fertilized ovum. 3. Ischemic and Menstrual Phases (End of Cycle) ○ Hormones Involved: ■ Estrogen and Progesterone: Drop sharply as corpus luteum regresses. ■ Endometrial Response: Reduced blood flow leads to ischemia and necrosis of the endometrial lining, resulting in menstruation. Key Points: ● The FSH and LH are crucial for follicle development and ovulation. ● Estrogen and progesterone prepare the endometrium for implantation and support its maintenance. ● Hormonal changes throughout the cycle regulate the development and release of the ovum and the preparation and shedding of the endometrial lining. Researched and Edited by PNLE PREP on Tiktok 1
Confirmation of Pregnancy Presumptive Indications of Pregnancy ● Amenorrhea ○ Absence of menstruation in a sexually active woman with regular cycles. ○ Menses cease due to progesterone and estrogen from the corpus luteum. ○ Implantation bleeding may occur in 30-40% of pregnancies. ● Nausea and Vomiting ○ Experienced by 60-80% of women, starting at 4-8 weeks, resolving by 10-12 weeks. ○ Can persist into the third trimester in 45% of cases. ○ Linked to increased hCG, estrogen, and decreased gastric motility. ● Fatigue ○ Common during the first trimester. ○ Likely related to hormonal changes, particularly progesterone. ● Urinary Frequency ○ Begins in early pregnancy, persists as the uterus expands and pressures the bladder. ○ Increases late in the third trimester due to fetal position. ● Breast and Skin Changes ○ Breast tenderness, fullness, and pigmentation changes by 6 weeks. ○ Increased pigmentation such as melasma and linea nigra due to hormonal effects. ● Vaginal and Cervical Color Change ○ Chadwick’s Sign: cervix, vagina, and labia turn a dark bluish-purple by 8 weeks due to increased vascularity. ● Fetal Movement ○ Noted between 16-20 weeks of gestation. ○ Early movements may be perceived sooner but are generally subtle Probable Signs of Pregnancy ● Abdominal Enlargement ○ Reliable indication when associated with gradual uterine growth. ○ More definitive when combined with amenorrhea. ● Ballottement ○ Fetus rises and then rebounds in the amniotic fluid when the cervix is tapped. ○ Indicative but may also be due to other factors like polyps. ● Cervical Softening (Goodell’s Sign) ○ Softening of the cervix due to pelvic vasocongestion, noticeable during pelvic examination. ● Changes in Uterine Consistency (Hegar’s Sign) ○ Softening of the lower uterine segment to the thinness of paper, typically observable 6-8 weeks after the last menstrual period. ○ Allows easy flexion of the uterus against the cervix. ● Braxton Hicks Contractions ○ Irregular, painless contractions that increase in frequency and strength, especially in the third trimester. ○ Differentiating from preterm labor can be challenging; consult a healthcare provider if contractions exceed five to six per hour or other labor signs are present. ● Palpation of the Fetal Outline ○ By mid-pregnancy, an experienced practitioner can palpate the fetal outline, with ease increasing as the pregnancy progresses. ● Uterine Souffle ○ A soft, blowing sound over the uterus due to blood flow through dilated uterine vessels, matching the maternal pulse rate. Researched and Edited by PNLE PREP on Tiktok 2

○ A) Chadwick’s Sign ○ B) Goodell’s Sign ○ C) Hegar’s Sign ○ D) Ballottement Answer: B) Goodell’s Sign 6. What does the term “ballottement” refer to in pregnancy? ○ A) A soft, blowing sound over the uterus ○ B) The fetus floating upward and then rebounding in amniotic fluid ○ C) Softening of the lower uterine segment ○ D) Visualization of the embryo or fetus Answer: B) The fetus floating upward and then rebounding in amniotic fluid 7. When is it most appropriate for a home pregnancy test to be conducted for the most accurate result? ○ A) In the afternoon ○ B) In the evening ○ C) After drinking a lot of fluids ○ D) With the first morning urine Answer: D) With the first morning urine 8. Which of the following could cause a false-negative result on a pregnancy test? ○ A) Hematuria ○ B) False-positive result ○ C) Dilute urine ○ D) Presence of fetal movement Answer: C) Dilute urine 9. At what gestational age can fetal movements typically be felt by an experienced examiner? ○ A) 8-10 weeks ○ B) 12-14 weeks ○ C) 16-20 weeks ○ D) 24-28 weeks Answer: C) 16-20 weeks 10. What is the main difference between the uterine souffle and the funic souffle? ○ A) Uterine souffle is a soft, blowing sound over the umbilical cord ○ B) Funic souffle is a sound corresponding to the maternal pulse ○ C) Uterine souffle corresponds to the maternal pulse, while funic souffle corresponds to the fetal heart rate ○ D) Funic souffle is heard over the uterine vessels Answer: C) Uterine souffle corresponds to the maternal pulse, while funic souffle corresponds to the fetal heart rate 11. Which sign is most likely to be observed first during a physical examination for pregnancy? ○ A) Visualization of the embryo or fetus ○ B) Cervical softening ○ C) Fetal heart sounds ○ D) Palpation of the fetal outline Answer: B) Cervical softening 12. How can an experienced practitioner feel the outlines of the fetal body? ○ A) By palpating the cervix ○ B) By auscultating the fetal heart ○ C) By examining the maternal blood ○ D) By palpating the abdomen Answer: D) By palpating the abdomen Researched and Edited by PNLE PREP on Tiktok 4