Midwife Licensure Exam Normal Pregnancy, Labor & Postpartum — Normal Pregnancy: Physiologic & Psychological ChangesCheat Sheet
One-page cheat sheet for Midwife Licensure Exam Normal Pregnancy, Labor & Postpartum — Normal Pregnancy: Physiologic & Psychological Changes. Every formula, definition, and key fact you need for this chapter, condensed to a single printable page. Designed for the final review session before the Midwife Licensure Exam 2026.
Exam context
For the Midwife Licensure Examination, Professional Regulation Commission (PRC) — Board of Midwifery tests Normal Pregnancy, Labor & Postpartum under a "Core" label, with Normal Pregnancy: Physiologic & Psychological Changes in the 1st slot across 4 chapters. Midwife Licensure Exam candidates must clear the 75% weighted average cut on the 2026 paper, which draws about a meaningful share of Normal Pregnancy, Labor & Postpartum questions. Date to watch: April and November 2026 (expected).
Normal Pregnancy: Physiologic & Psychological Changes - Cheat Sheet
Your last-minute revision companion for the NLE. Master the signs of pregnancy, maternal adaptations, fetal milestones, danger signs, and calculation rules. Everything you need in 30 minutes.
Sections
Common Values
Value
110–160 beats per minute
Symbol
FHR
Quantity
Fetal heart rate range
Value
10–12 weeks
Symbol
N/A
Quantity
Weeks when Doppler detects FHR
Value
18–20 weeks
Symbol
N/A
Quantity
Weeks when fetoscope detects FHR
Value
18–20 weeks
Symbol
N/A
Quantity
Weeks of first quickening (primigravida)
Value
16 weeks
Symbol
N/A
Quantity
Weeks of first quickening (multipara)
Section Title
Signs of Pregnancy (Presumptive, Probable, Positive)
Important Facts
- Only FHT heard by examiner, examiner-felt fetal movement, or ultrasound visualisation = positive diagnosis.
- Positive pregnancy test (hCG) is PROBABLE, not positive — rare non-pregnant conditions can raise hCG.
- Doppler detects FHR ~10–12 weeks; fetoscope ~18–20 weeks.
- Quickening felt by mother is presumptive; if examiner feels it, that is positive.
- All three probable signs can occur in non-pregnant women with other conditions.
- Chadwick's sign appears early (~8–10 weeks) and is reliable probable sign.
- Absence of these signs does NOT rule out pregnancy; positive signs do rule it in.
Key Definitions
Term
Presumptive Signs
Example
A woman reports she hasn't had her period for 6 weeks — presumptive, not yet confirmed.
Definition
Subjective symptoms felt by the woman; unreliable alone (amenorrhoea, nausea, breast tenderness, urinary frequency, fatigue, quickening).
Term
Probable Signs
Example
Cervical softening (Goodell's) + positive urine hCG test = probable pregnancy, not diagnostic.
Definition
Objective findings observed by the examiner; suggest pregnancy but not conclusive (Goodell's, Hegar's, Chadwick's signs, ballottement, Braxton Hicks, positive hCG test).
Term
Positive (Diagnostic) Signs
Example
FHR detected by Doppler at 11 weeks = positive diagnosis of pregnancy.
Definition
Only three signs confirm pregnancy: fetal heart tones heard by examiner, fetal movement felt by examiner, or fetus visualized on ultrasound.
Term
Goodell's Sign
Example
Cervix feels like the lips (soft) instead of the tip of the nose (firm).
Definition
Softening of the cervix in pregnancy (due to increased vascularity and oedema).
Term
Hegar's Sign
Example
Examiner's fingers meet with little resistance when the lower segment is compressed between suprapubic and vaginal hands.
Definition
Softening of the lower uterine segment (isthmus) between the cervix and fundus; palpable by bimanual exam.
Term
Chadwick's Sign
Example
Cervix appears deep blue or purple instead of its normal pink colour.
Definition
Bluish-violet discolouration of the cervix, vagina, and vulva due to increased vascularity.
Term
Ballottement
Example
Tapping the lower uterus causes a fluid wave; the fetus bounces back like a cork in water.
Definition
The fetus rebounds when the lower uterine segment is tapped gently; indicates a mobile fetus.
Term
Quickening
Example
A first-time mother feels fluttering sensations in her lower abdomen at 19 weeks.
Definition
First fetal movements felt by the mother; ~18–20 weeks in primigravidas, ~16 weeks in multiparas.
Term
Braxton Hicks Contractions
Example
Abdomen tightens for a few seconds, then relaxes; no cervical change or progression.
Definition
Painless, irregular, practice uterine contractions beginning ~6 weeks but notable in the third trimester; not true labour.
Term
Leukorrhea
Example
Mild white discharge increases as pregnancy progresses; caused by oestrogen and increased vascularity.
Definition
Increased vaginal discharge in pregnancy; white, non-itchy, and non-foul-smelling is normal.
Diagrams To Know
- Pyramid or triangle showing hierarchy: Presumptive (base, many) → Probable (middle, fewer) → Positive (apex, only 3)
- Timeline of signs: Amenorrhoea (first), nausea (1–2 weeks later), Chadwick's (~8 wk), Goodell's/Hegar's (~8–12 wk), FHR by Doppler (~10–12 wk), quickening (~16–20 wk)
Common Values
Value
40–50%
Symbol
N/A
Quantity
Blood volume increase
Value
30–50%
Symbol
N/A
Quantity
Cardiac output increase
Value
10–15 bpm
Symbol
N/A
Quantity
Normal heart rate increase
Value
Hgb <11 g/dL
Symbol
N/A
Quantity
Anaemia threshold (1st/3rd trimester)
Value
Hgb <10.5 g/dL
Symbol
N/A
Quantity
Anaemia threshold (2nd trimester)
Value
≥140/90 mmHg
Symbol
N/A
Quantity
BP rise indicating concern
Value
~20%
Symbol
N/A
Quantity
Oxygen consumption increase
Value
~4 cm
Symbol
N/A
Quantity
Diaphragm elevation
Section Title
Maternal Physiologic Changes by System
Important Facts
- Blood volume ↑ 40–50%; plasma ↑ more than RBCs → dilutional anaemia.
- Cardiac output ↑ 30–50%; heart rate ↑ 10–15 bpm normal.
- BP typically falls slightly 2nd trimester, returns to baseline 3rd; ≥140/90 mmHg = screen for pre-eclampsia.
- Oxygen consumption ↑ ~20%; progesterone drives deeper breathing (mild respiratory alkalosis normal).
- Dyspnoea and nasal stuffiness/epistaxis are normal from mucosal congestion.
- GFR ↑, urinary frequency ↑; mild glycosuria normal but persistent = gestational diabetes screen.
- Cardiac sphincter relaxation → heartburn; progesterone slows peristalsis → constipation and haemorrhoids.
- Joints/ligaments soften (relaxin); centre of gravity shifts → lordotic posture, back pain, waddling gait.
- Diaphragm pushed up ~4 cm; fundus reaches xiphoid process near term.
- Insulin resistance ↑ in 3rd trimester to shunt glucose to fetus.
Key Definitions
Term
Physiologic Anaemia of Pregnancy
Example
A pregnant woman's Hgb drops from 12 to 10.5 g/dL due to plasma expansion, not true blood loss — this is normal.
Definition
Dilutional anaemia caused by blood volume increase (40–50%) outpacing RBC increase; Hgb <11 g/dL (1st/3rd trimester) or <10.5 g/dL (2nd) is anaemia.
Term
Supine Hypotensive (Vena Cava) Syndrome
Example
Pregnant woman lies flat, feels lightheaded; turn to left lateral position immediately to relieve compression.
Definition
Compression of the inferior vena cava by the gravid uterus when supine, causing dizziness, hypotension, and tachycardia.
Term
Linea Nigra
Example
A brownish-black line becomes visible on the abdomen and fades post-delivery.
Definition
Dark vertical line from the umbilicus to the pubis, caused by increased melanin; appears in ~75% of pregnancies.
Term
Chloasma (Melasma)
Example
Forehead and cheeks develop blotchy brown discolouration during pregnancy.
Definition
Symmetric brown patches on the face ('mask of pregnancy'), caused by oestrogen and UV exposure; may persist postpartum.
Term
Striae Gravidarum
Example
Purple-red streaks on abdomen, breasts, and thighs appear and gradually fade to white lines.
Definition
Stretch marks from rapid skin stretching; silvery after delivery but may remain visible.
Term
Ptyalism
Example
Woman reports difficulty swallowing; ptyalism resolves by second trimester for most.
Definition
Excess salivation in pregnancy; usually first trimester, associated with nausea.
Term
Pica
Example
Pregnant woman craves ice or laundry starch; assess nutritional deficiency and counsel on safety.
Definition
Craving of non-food substances (ice, starch, clay, dirt); must be screened and discouraged.
Diagrams To Know
- Cardiovascular changes: Blood volume +40–50% → Plasma ↑↑ > RBC ↑ → Hgb ↓ (physiologic anaemia) + HR ↑ + CO ↑
- Respiratory: Progesterone → ↑ ventilation → ↑ O2 consumption → mild respiratory alkalosis (normal)
- GI: ↓ Cardiac sphincter tone → heartburn; ↓ peristalsis → constipation/haemorrhoids; ↑ salivation → ptyalism
Common Values
Value
~3–4 weeks
Symbol
N/A
Quantity
Fetal heart beat begins
Value
~10–12 weeks
Symbol
N/A
Quantity
FHR audible by Doppler
Value
~12 weeks
Symbol
N/A
Quantity
Sex distinguishable
Value
~18–20 weeks
Symbol
N/A
Quantity
Quickening (primigravida)
Value
~16 weeks
Symbol
N/A
Quantity
Quickening (multipara)
Value
≥2:1
Symbol
N/A
Quantity
L/S ratio for lung maturity
Value
~34–36 weeks
Symbol
N/A
Quantity
Surfactant adequate by
Value
~24 weeks
Symbol
N/A
Quantity
Age of viability
Value
500–1,000 mL
Symbol
N/A
Quantity
Amniotic fluid volume at term
Value
37–42 weeks
Symbol
N/A
Quantity
Term range
Value
39–40⁶ weeks
Symbol
N/A
Quantity
Full term
Value
2 arteries + 1 vein
Symbol
AVA
Quantity
Normal umbilical cord
Section Title
Fetal Development & Milestones
Important Facts
- Weeks 3–8 (embryonic) = organogenesis = GREATEST teratogen vulnerability; any major insult causes organ defects.
- Fetal heart begins to beat ~3–4 weeks (before woman knows she's pregnant).
- Sex distinguishable on ultrasound ~12 weeks.
- Quickening ~16–20 weeks (primigravidas), ~16 weeks (multiparas).
- Vernix and lanugo develop mid-pregnancy to protect skin.
- Surfactant adequate by ~34–36 weeks; L/S ratio ≥2:1 = lung maturity.
- Age of viability ~24 weeks; before this, survival is not possible even with care.
- Term = 37–42 weeks; full term = 39–40⁶ weeks.
- Placenta fully functional by ~12 weeks; exchanges O₂, nutrients, waste, and produces hormones.
- Single umbilical artery (SUA) instead of normal 2 arteries + 1 vein requires newborn screening.
Key Definitions
Term
Pre-embryonic Stage
Example
Zygote divides into blastocyst and implants in uterine wall by day 7–10.
Definition
Weeks 1–2; fertilisation, cleavage, and implantation; no organs yet.
Term
Embryonic Stage
Example
Heart, brain, lungs, limbs, and GI tract form; any teratogenic exposure here causes severe defects.
Definition
Weeks 3–8; organogenesis (all major organ systems form); GREATEST teratogen vulnerability.
Term
Fetal Stage
Example
Lungs produce surfactant, brain continues to develop, weight increases dramatically.
Definition
Week 9 to birth; growth and maturation of formed structures; organs refine, not new organ formation.
Term
Vernix Caseosa
Example
Newborn is covered in white, cheese-like coating that washes off after delivery.
Definition
Waxy, white protective coating on fetal skin; prevents maceration from amniotic fluid.
Term
Lanugo
Example
Preterm infant has visible fine body hair; term infant has minimal lanugo, mainly on ears and shoulders.
Definition
Fine, soft fetal hair covering the body (especially back, shoulders, ears); sheds by term or shortly after.
Term
Surfactant
Example
L/S ratio ≥2:1 indicates mature fetal lungs; <1:5 = respiratory distress risk if born now.
Definition
Phospholipid (primarily lecithin) that reduces surface tension in alveoli, allowing lung expansion; critical for breathing after birth.
Term
Age of Viability
Example
An extremely preterm infant born at 24 weeks has chance of survival but faces respiratory and neurologic challenges.
Definition
~24 weeks; fetus may survive outside uterus with intensive care (lung immaturity is the limiting factor).
Term
Amniotic Fluid Volume
Example
Polyhydramnios (excess) or oligohydramnios (deficiency) are associated with fetal anomalies.
Definition
500–1,000 mL at term; protects fetus, allows movement, maintains temperature, and aids fetal lung development.
Term
Umbilical Cord
Example
Normal cord has 2 umbilical arteries + 1 umbilical vein; SUA may indicate renal or cardiac anomalies.
Definition
Contains 2 arteries and 1 vein (AVA); single umbilical artery (SUA) warrants closer newborn assessment.
Diagrams To Know
- Timeline of organogenesis: Weeks 3–8 marked as 'critical period' for teratogen sensitivity
- Surfactant maturation: 28 weeks (some) → 32–34 weeks (accelerating) → 34–36 weeks (adequate)
- Fetal circulation shunts: Ductus venosus (bypasses liver), foramen ovale (right-to-left), ductus arteriosus (pulmonary to aorta)
Formulas
Formula
Naegele's Rule: EDD = LMP − 3 months + 7 days (± adjust year if needed)
Meaning
LMP = first day of last menstrual period; EDD = estimated date of delivery (due date); assumes regular 28-day cycle.
Watch Out
Year adjustment is easy to miss. If LMP is Jan–Mar, subtract 1 year after adding 7 days. If LMP is Sept–Dec, add 1 year. Many students forget this. Always double-check the year.
When To Use
When LMP is known and cycle is regular; apply at first prenatal visit to establish dating.
Formula
McDonald's Rule: Fundal height in cm ≈ gestational age in weeks (±2 cm) [after 20 weeks]
Meaning
Fundal height measured from top of symphysis pubis to top of fundus; accurate within ±2 weeks.
Watch Out
Does NOT work before 20 weeks. Also unreliable if maternal obesity, multiple gestation, polyhydramnios, or oligohydramnios. Accuracy decreases as pregnancy advances; most useful 20–35 weeks.
When To Use
Weeks 20–36; quick estimate of gestational age during routine prenatal exams.
Common Values
Value
At or slightly above symphysis pubis
Symbol
N/A
Quantity
Fundal height at 12 weeks
Value
At or slightly above umbilicus
Symbol
N/A
Quantity
Fundal height at 20 weeks
Value
Near xiphoid process
Symbol
N/A
Quantity
Fundal height at 36 weeks
Value
±2 cm
Symbol
N/A
Quantity
McDonald's accuracy margin
Value
37–42 weeks
Symbol
N/A
Quantity
Gestational age range for term
Value
39–40⁶ weeks
Symbol
N/A
Quantity
Full term (optimal)
Value
280 days (~40 weeks)
Symbol
N/A
Quantity
Average duration from LMP to delivery
Section Title
Estimating Due Date (Naegele's Rule & McDonald's Rule)
Important Facts
- Naegele assumes regular 28-day cycle; cycles >30 or <26 days require adjustment.
- EDD is an estimate; only ~5% deliver exactly on due date; 80% deliver within ±2 weeks.
- LMP accurate only if woman remembers it clearly; early ultrasound dating is more reliable.
- Fundal height landmarks: symphysis pubis ~12 wk, umbilicus ~20 wk, xiphoid ~36 wk.
- McDonald's rule accuracy ±2–3 weeks; decreases with advancing pregnancy and maternal factors.
- GTPAL helps track obstetric history quickly; always record in this order.
- Preterm = before 37 weeks; term = 37–42 weeks; postterm = >42 weeks.
Key Definitions
Term
GTPAL / Gravida-Para Notation
Example
Woman pregnant with 1 prior term birth and 1 living child = G2 T1 P0 A0 L1.
Definition
G (gravida/total pregnancies including current) T (term births ≥37 wk) P (preterm 20–36⁶ wk) A (abortions <20 wk) L (living children).
Term
Estimated Date of Delivery (EDD)
Example
LMP 10 August 2025 → EDD 17 May 2026 (within normal range 10 May–24 May).
Definition
Due date calculated by Naegele's rule; ranges ±2 weeks. Baby 'on due date' only ~5% of the time.
Term
Gestational Age
Example
At LMP +280 days, gestational age is term (~40 weeks).
Definition
Age of pregnancy from first day of LMP; expressed in weeks + days (e.g., 28⁵ = 28 weeks 5 days).
Diagrams To Know
- Fundal height growth chart: 12 wk (symphysis), 16 wk (between symphysis and umbilicus), 20 wk (umbilicus), 36 wk (xiphoid), then drops with lightening
- Naegele's rule step-by-step: Pick LMP date → Subtract 3 months → Add 7 days → Check year → Result is EDD
Reactions Or Equations
Note
Example: LMP 10 Aug 2025 → Aug − 3 = May; May 10 + 7 days = May 17; year stays 2026 → EDD 17 May 2026.
Equation
EDD = LMP − 3 months + 7 days + [1 year if LMP in Jan–Mar; −0 if Apr–Dec]
Conditions
Applies only to regular 28-day cycles; if irregular, subtract/add days for cycle length difference.
Section Title
Psychological Changes & Maternal Tasks (Rubin's Framework)
Important Facts
- First trimester: Ambivalence is NORMAL, even in planned pregnancies; focus is on self ('Am I really pregnant?').
- Second trimester: Acceptance grows; quickening makes baby 'real'; woman becomes introspective and increasingly attached.
- Third trimester: Preparation mode; anxiety about labour; readiness to end pregnancy; nesting behaviour.
- Rubin's maternal tasks: (1) ensuring safe passage, (2) seeking acceptance by others, (3) binding-in, (4) giving of oneself.
- Body image changes may trigger anxiety; validate feelings and involve partner in adapting to physical changes.
- Mood lability is hormonal; screen for depression at every visit (Edinburgh Postnatal Depression Scale applicable in pregnancy).
- Screen for intimate-partner violence; may begin or escalate during pregnancy — ask in private, non-judgmental manner.
- Involve partner and family to strengthen support system; partner's involvement improves maternal outcomes.
- Sleep disturbances and anxiety in third trimester are normal but persistent depression warrants referral.
- Social support is protective against depression and postpartum complications.
Key Definitions
Term
Ambivalence
Example
A woman excited about her pregnancy also worries about miscarriage, career impact, and motherhood — both feelings are normal.
Definition
Mixed emotions (joy + anxiety, acceptance + uncertainty) common especially in the first trimester, even in wanted pregnancies.
Term
Introspection
Example
Pregnant woman becomes more reflective, daydreams about the baby, reviews her own childhood experiences.
Definition
Turning inward psychologically; common in second trimester as woman bonds with the fetus.
Term
Binding-In (Attachment)
Example
Woman talks to baby, plans nursery, and feels protective toward the pregnancy.
Definition
Psychological attachment to the fetus; accelerates after quickening and increases throughout pregnancy.
Term
Lightening (Dropping)
Example
Pregnant woman notices easier breathing, more bladder pressure, and lower abdominal profile.
Definition
Fetal descent into the pelvis; occurs ~2–4 weeks before labour in first pregnancy, during labour in multiparas.
Term
Nesting Instinct
Example
Woman scrubs floors, organizes nursery, buys baby items in the weeks before labour — normal and healthy.
Definition
Third-trimester urge to prepare home and gather supplies; psychological preparation for labour and newborn arrival.
Term
Couvade Syndrome
Example
Husband develops morning sickness, breast tenderness, or weight gain along with pregnant wife.
Definition
Partner experiences pregnancy-like symptoms (nausea, weight gain, fatigue); psychosomatic response to impending fatherhood.
Diagrams To Know
- Trimester-based emotional progression: 1st (ambivalence) → 2nd (acceptance + introspection) → 3rd (preparation + nesting)
- Attachment curve: Weak early → Quickening (boost) → Ultrasound (boost) → Birth (peak)
- Rubin's 4 maternal tasks with examples for each trimester
Section Title
Common Discomforts & Relief Measures (Patient Teaching)
Important Facts
- NAUSEA/VOMITING: Small, frequent, dry carbohydrate snacks; avoid empty stomach, strong odours, and greasy food; ginger, vitamin B6, acupressure bands may help; usually eases by 12–16 weeks.
- HEARTBURN: Small frequent meals; remain upright for 2 hours post-eating; avoid fatty, spicy, acidic food; antacids only as advised (avoid aspirin/NSAIDs).
- CONSTIPATION: Increase fibre, fluids, and activity; iron supplements worsen it (adjust if needed); stool softeners safe in pregnancy.
- BACKACHE: Good posture, pelvic tilt exercises, maternity belt, low-heeled supportive shoes; avoid prolonged standing.
- LEG CRAMPS: Dorsiflex the foot, stretch calf muscles, ensure adequate calcium and magnesium; sudden onset may indicate thrombosis — assess for DVT signs.
- VARICOSITIES/OEDEMA: Elevate legs, avoid crossing legs and prolonged standing, use compression stockings, left-lateral rest; mild oedema is normal.
- URINARY FREQUENCY: Normal; teach to report dysuria (UTI), urine with blood (haematuria), or incomplete emptying (retention).
- NASAL STUFFINESS/EPISTAXIS: From mucosal congestion; use saline rinse; avoid nasal decongestants; reassure it resolves postpartum.
- HEMORRHOIDS: Prevent constipation (above), warm sitz baths, topical treatments safe in pregnancy; usually improve postpartum.
- INSOMNIA (3rd trimester): Encourage daytime rest, avoid caffeine, warm milk before bed, support pillows for positioning; reassure it's normal.
Key Definitions
Term
Hyperemesis Gravidarum
Example
Woman unable to keep down food/fluids; loses >5% pre-pregnancy weight; may need hospital admission.
Definition
Severe, persistent vomiting in pregnancy causing dehydration, electrolyte imbalance, and weight loss; requires IV fluid replacement.
Diagrams To Know
- Discomfort × Trimester matrix showing which symptoms peak in each trimester
Common Values
Value
≥10 movements in 2 hours (or 3+ in 1 hour)
Symbol
N/A
Quantity
Fetal movement count goal
Value
≥140/90 mmHg
Symbol
N/A
Quantity
Threshold for gestational hypertension
Value
<37 weeks
Symbol
N/A
Quantity
Weeks defining preterm labour onset
Section Title
Prenatal Danger Signs (Teach Every Pregnant Woman)
Important Facts
- VAGINAL BLEEDING: Any amount, any trimester is concerning — assess for placenta previa, abruption, miscarriage, cervicitis, or subchorionic haematoma.
- GUSH/LEAKING FLUID: Possible rupture of membranes (ROM); risk of infection (chorioamnionitis) and preterm labour; confirm with ferning test and nitrazine paper.
- SEVERE/PERSISTENT HEADACHE: Concerning for pre-eclampsia, especially with other signs; measure BP, check reflexes, assess for visual changes.
- BLURRED VISION/SPOTS BEFORE EYES: Possible pre-eclamptic symptoms; also ask about photopsia (flashing lights); indicate visual scotomata.
- FACIAL/HAND OEDEMA + HEADACHE: Classic pre-eclampsia combination; distinguish from normal pregnancy oedema (lower legs, non-facial).
- EPIGASTRIC OR RUQ PAIN: Red flag for severe pre-eclampsia or HELLP syndrome; assess for nausea, vomiting, tenderness.
- PERSISTENT VOMITING: Risk of hyperemesis gravidarum; assess hydration, electrolytes, and weight loss.
- FEVER & CHILLS: Possible infection (UTI, chorioamnionitis, appendicitis, pneumonia); assess for other localized signs.
- DYSURIA: UTI; untreated UTI in pregnancy risks pyelonephritis and preterm labour; culture and treat with safe antibiotics.
- ABSENT/MARKEDLY DECREASED FETAL MOVEMENT: After quickening, <3 movements in 1 hour or <10 in 2 hours is concerning; perform non-stress test (NST) to assess fetal well-being.
- REGULAR CONTRACTIONS <37 WEEKS: Preterm labour; assess cervical dilation, rupture of membranes, fetal well-being.
- CONVULSIONS: Eclampsia; EMERGENCY; airway management, magnesium sulfate, prepare for delivery.
Key Definitions
Term
Preterm Labour
Example
Woman at 34 weeks reports regular contractions every 5 minutes; cervical exam shows 2 cm dilation — notify provider immediately.
Definition
Regular uterine contractions with cervical change before 37 weeks; threatens fetal viability and neonatal outcomes.
Term
Placental Abruption
Example
Woman at 35 weeks with sudden severe abdominal pain and vaginal bleeding; fundus is irritable; monitor for signs of shock.
Definition
Premature separation of placenta from uterine wall; presents with vaginal bleeding, abdominal pain, and shock.
Term
Placenta Previa
Example
Woman with intermittent painless vaginal bleeding; ultrasound confirms placenta over cervix; bed rest and pelvic rest advised.
Definition
Placenta covers internal cervical os; causes painless vaginal bleeding; diagnosed by ultrasound.
Term
Pre-eclampsia
Example
Woman at 32 weeks: BP 158/98 mmHg, severe frontal headache, visual spots, RUQ pain; suspect pre-eclampsia; emergency referral.
Definition
Gestational hypertension (≥140/90 mmHg) + proteinuria and/or signs of end-organ dysfunction (headache, vision, epigastric pain, thrombocytopenia).
Term
Eclampsia
Example
Woman with pre-eclampsia develops tonic-clonic seizure; manage airway, administer magnesium sulfate IV, call for emergency delivery.
Definition
Pre-eclampsia + convulsions; life-threatening obstetric emergency; magnesium sulfate is first-line seizure prophylaxis/treatment.
Diagrams To Know
- Pre-eclampsia vs. eclampsia: Pre-eclampsia (HTN + proteinuria/end-organ signs) → Eclampsia (+ seizures)
- Decision tree for vaginal bleeding in pregnancy: Painless → Placenta previa; Painful + contracted uterus → Abruption; Early + cramping → Miscarriage
Common Values
Value
11.5–16 kg (25–35 lbs)
Symbol
N/A
Quantity
Recommended weight gain (normal BMI)
Value
7–11.5 kg (15–25 lbs)
Symbol
N/A
Quantity
Recommended weight gain (overweight BMI)
Value
5–9 kg (11–20 lbs)
Symbol
N/A
Quantity
Recommended weight gain (obese BMI)
Value
~300 kcal/day (extra)
Symbol
N/A
Quantity
Additional daily caloric need
Section Title
Nursing Assessment & Management (Core Competencies)
Important Facts
- Confirm & date pregnancy: History (LMP, cycle regularity) + hCG test + physical signs + early ultrasound when possible.
- Obstetric history: Record GTPAL, prior complications (GDM, pre-eclampsia, early deliveries, losses), interpregnancy interval (closely spaced = ↑ risk).
- Baseline vitals & weight: Establish baseline BP (to detect hypertension later); record pre-pregnancy weight (normal gain 11.5–16 kg; overweight 7–11.5 kg; obese 5–9 kg).
- Fetal assessment: FHR (110–160 bpm normal), fundal height (≈ weeks after 20 wk ±2 cm), Leopold's manoeuvres (after 20 wk), fetal movement (quickening ~16–20 wk).
- Psychosocial screen: Mood, support system, readiness for pregnancy, depression screening (EPDS), intimate-partner violence screening (HITS, HARK).
- Normalise expected changes: Educate about physiology so woman is not alarmed by normal findings; clearly distinguish danger signs.
- Support self-care: Nutrition (extra ~300 kcal/day, iron, folate, calcium), rest (8–10 hr/night), moderate activity (unless restricted), left-lateral rest position.
- Anticipatory guidance: 1st trim = coping with nausea, ambivalence, early screening; 2nd = attachment, comfort, anatomy scan; 3rd = labour prep, breastfeeding, newborn care.
- Reinforce compliance: All prenatal visits, iron/folate supplements, immunisations (Td, influenza, COVID-19 as per guidelines), tetanus booster.
Key Definitions
Term
Leopold's Manoeuvres
Example
1st manoeuvre = identify fundus contents (head vs buttocks); 2nd = locate back/extremities; 3rd = confirm presentation; 4th = assess engagement.
Definition
Four-part abdominal palpation technique to determine fetal position, presentation, and engagement; performed after 20 weeks.
Term
Fetal Movement Counting
Example
Teach mother to lie on left side, count distinct movements from 9 AM until 10 kicks felt (or 2 hours pass); document time.
Definition
Mother counts fetal kicks daily; <10 movements in 2 hours or <3 in 1 hour after quickening warrants NST.
Diagrams To Know
- Nursing process applied to normal pregnancy: Assessment → Diagnosis (often wellness-focused) → Planning → Intervention → Evaluation
- Leopold's manoeuvres sequence: 1st (fundus) → 2nd (sides) → 3rd (suprapubic) → 4th (upper pole)
Must Remember
- ONLY 3 POSITIVE (DIAGNOSTIC) SIGNS: Fetal heart tones heard by examiner, fetal movement felt by examiner, fetus visualized on ultrasound. A positive pregnancy test is PROBABLE, not positive.
- NAEGELE'S RULE: LMP − 3 months + 7 days (adjust year if LMP in Jan–Mar or Sept–Dec). Common mistake: forgetting year adjustment.
- BLOOD VOLUME ↑ 40–50%; Plasma ↑↑ > RBC → physiologic dilutional anaemia. Normal: Hgb <11 g/dL (trim 1/3) or <10.5 g/dL (trim 2) is anaemia, not always pathologic without clinical signs.
- SUPINE HYPOTENSIVE SYNDROME: Heavy uterus compresses IVC when supine → dizziness, hypotension. Solution: Left lateral position immediately.
- ORGANOGENESIS (WEEKS 3–8): Period of GREATEST teratogen vulnerability. Insult here causes organ defects. First trimester is critical.
- FUNDAL HEIGHT: ~12 wk (symphysis pubis), ~20 wk (umbilicus), ~36 wk (xiphoid); after 20 wk, cm ≈ weeks (±2). McDonald's rule invalid <20 wk and >36 wk.
- QUICKENING: 18–20 weeks primigravidas, 16 weeks multiparas. Mother feels it (presumptive); if examiner feels it, it's POSITIVE.
- FETAL HEART RATE: 110–160 bpm normal. Doppler ~10–12 weeks; fetoscope ~18–20 weeks.
- AMBIVALENCE IN FIRST TRIMESTER IS NORMAL: Even in planned pregnancies. Introspection peaks 2nd trimester; nesting/preparation in 3rd.
- PRENATAL DANGER SIGNS TO TEACH EVERY WOMAN: Vaginal bleeding (any amount), gush/leak of fluid, severe headache + vision changes + epigastric pain (pre-eclampsia), fever, persistent vomiting, dysuria, absent fetal movement (after quickening), regular contractions <37 wk, convulsions.
Last Minute Tips
- When given an LMP, ALWAYS double-check the year with Naegele's rule. Many NLE questions test year adjustment; don't miss it. Example: LMP Jan 15 = subtract 3 mo → Oct 15 previous YEAR, then +7 days → Oct 22 previous year = EDD.
- Distinguish PRESUMPTIVE (felt by mother) from POSITIVE (examiner detects or sees). The NLE loves this distinction. A positive hCG test is still PROBABLE because rare non-pregnant conditions can raise hCG.
- Remember the THREE positive signs are FHT (heard), fetal movement (felt by examiner, not mother), and ultrasound visualization. Quickening felt by mother is presumptive, not positive.
- Pre-eclampsia RED FLAGS are SEVERE HEADACHE + VISION CHANGES + EPIGASTRIC PAIN ± facial/hand oedema. Teach women to report these immediately. Eclampsia = pre-eclampsia + seizure = EMERGENCY.
- Supine hypotensive syndrome = left-side position immediately. This is high-yield for application-based NLE questions about positioning and maternal safety.
Comparison Tables
Rows
Values
- Least reliable
- Yes, subjective
- Amenorrhoea, nausea, breast tenderness, urinary frequency, fatigue, quickening
- Each has other non-pregnant causes
Property
Presumptive
Values
- More reliable
- No, observed by examiner
- Goodell's, Hegar's, Chadwick's, ballottement, Braxton Hicks, positive hCG test, abdominal enlargement
- Can occur in non-pregnant conditions; hCG rare false-positives
Property
Probable
Values
- Definitive
- Examiner detects, not mother
- FHT heard by Doppler/fetoscope, examiner-felt fetal movement, fetus on ultrasound
- None — these confirm pregnancy 100%
Property
Positive (Diagnostic)
Columns
- Sign Category
- Reliability
- Felt by Mother?
- Examples
- Key Limitation
Table Title
Presumptive vs Probable vs Positive Signs of Pregnancy
Rows
Values
- ↑ 40–50%
- Begins 1st trim, peaks 3rd
- Plasma ↑↑ > RBC → dilutional anaemia
- Diagnose anaemia at Hgb <11 (trim 1/3) or <10.5 (trim 2); no tx usually needed
Property
Blood Volume
Values
- ↑ 30–50%
- Throughout pregnancy
- Compensates for increased metabolic demand
- Monitor for cardiac complications in women with heart disease
Property
Cardiac Output
Values
- ↑ 10–15 bpm
- Gradual throughout
- Normal adaptation; tachycardia >100 may indicate infection/anaemia
- Distinguish normal from pathologic tachycardia; assess for symptoms
Property
Heart Rate
Values
- Slight ↓ 2nd trim, returns to baseline 3rd
- Mid-pregnancy dip, then recovery
- Normal; but ≥140/90 mmHg = screen for gestational HTN/pre-eclampsia
- Establish baseline early; recheck if elevated; assess for pre-eclampsia signs
Property
Blood Pressure
Values
- ↑ (hypercoagulability)
- Throughout pregnancy
- Protective at delivery but ↑ VTE risk
- Screen for thrombosis risk; counsel on DVT/PE prevention (leg elevation, movement)
Property
Coagulation Factors
Columns
- Parameter
- Change
- Timing
- Clinical Significance
- Nursing Action
Table Title
Maternal Cardiovascular & Haematologic Changes
Rows
Values
- Weeks 1–2
- Fertilisation, cleavage, implantation; no organs yet
- Low (all-or-nothing effect)
- Woman may not know she's pregnant; insult usually fatal, not teratogenic
Property
Pre-embryonic
Values
- Weeks 3–8
- Organogenesis; ALL major organ systems form
- GREATEST vulnerability
- Most critical period; avoid ALL teratogens (drugs, alcohol, infection, radiation, X-rays)
Property
Embryonic
Values
- Week 9 to birth
- Growth, maturation of formed organs; no new organs form
- Moderate (damage possible but organ basics set)
- Organ function refines; teratogens mainly cause growth restriction or functional impairment, not major structural defects
Property
Fetal
Columns
- Stage
- Duration
- Key Events
- Teratogen Vulnerability
- Clinical Implication
Table Title
Stages of Fetal Development
Rows
Values
- Ambivalence (normal, even wanted pregnancies)
- Confirming pregnancy reality; coping with nausea; physical self-adaptation
- Reassure ambivalence is normal; address nausea; early screening; establish support system
- Severe depression, suicidal ideation, inability to accept pregnancy
Property
First (0–12 weeks)
Values
- Acceptance; introspection; attachment growing
- Binding-in with fetus (quickening boosts this); body image acceptance
- Encourage talking to baby, planning nursery; discuss fetal development; comfort measures
- Persistent depression, lack of attachment, rejection of pregnancy, body image distortion
Property
Second (13–27 weeks)
Values
- Preparation; anticipatory anxiety about labour; readiness to end pregnancy
- Final nesting; labour & newborn preparation; psychological readiness
- Labour preparation classes, breastfeeding education, newborn care, partner involvement, postpartum expectations
- Extreme anxiety, fear of labour, rejection of pregnancy, depression, thoughts of harming baby
Property
Third (28–40+ weeks)
Columns
- Trimester
- Emotional Focus
- Key Psychological Task
- Nursing Teaching Emphasis
- Red Flag to Screen
Table Title
First vs Second vs Third Trimester — Psychological Characteristics
Rows
Values
- Calculate EDD from LMP
- Initial dating; any trimester if LMP known
- ±2 weeks (better early, worse late in pregnancy)
- Regular 28-day cycle; accurate LMP recall
- Year adjustment critical; irregular cycles need adjustment; early ultrasound confirms
Property
Naegele's Rule
Values
- Estimate gestational age from fundal height (cm ≈ weeks)
- Routine check weeks 20–36
- ±2–3 weeks
- Normal weight, single pregnancy, no poly/oligohydramnios
- Invalid <20 wk and >36 wk; unreliable if obesity, multiples, excess/deficient fluid; decreases late pregnancy
Property
McDonald's Rule
Columns
- Estimation Method
- Application
- Accuracy
- Requirements
- Watch Out
Table Title
Naegele's Rule vs McDonald's Rule — When to Use Each
Rows
Values
- ≥140/90 mmHg
- ≥160/110 mmHg (persistent)
- Same as severe
- Check BP, recheck in 15 min; if persistent ≥160/110, start magnesium sulfate, prepare for delivery
Property
BP
Values
- Mild
- Severe, frontal, unrelieved by OTC meds
- May precede seizure
- Immediate notification; assess vision, reflexes, assess for seizure prodrome
Property
Headache
Values
- Blurred vision
- Severe (scotomata, photopsia, temporary blindness)
- May precede seizure
- Same as severe; prepare for emergent delivery
Property
Visual Changes
Values
- None or mild epigastric discomfort
- Severe RUQ or epigastric pain (HELLP sign)
- May accompany convulsion
- Assess for HELLP; consider delivery; monitor for liver rupture
Property
Abdominal Pain
Values
- Absent
- Absent
- 1 or more tonic-clonic convulsions
- EMERGENCY: Airway, magnesium sulfate IV, prepare for immediate delivery
Property
Seizures
Columns
- Sign/Symptom
- Pre-eclampsia (without severe features)
- Severe Pre-eclampsia / HELLP
- Eclampsia
- Immediate Action
Table Title
Pre-eclampsia Warning Signs: Which are SEVERE?
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