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.
Signs of Pregnancy (Presumptive, Probable, Positive)
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)
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
Presumptive Signs
Example
A woman reports she hasn't had her period for 6 weeks — presumptive, not yet confirmed.
Subjective symptoms felt by the woman; unreliable alone (amenorrhoea, nausea, breast tenderness, urinary frequency, fatigue, quickening).
Probable Signs
Example
Cervical softening (Goodell's) + positive urine hCG test = probable pregnancy, not diagnostic.
Objective findings observed by the examiner; suggest pregnancy but not conclusive (Goodell's, Hegar's, Chadwick's signs, ballottement, Braxton Hicks, positive hCG test).
Positive (Diagnostic) Signs
Example
FHR detected by Doppler at 11 weeks = positive diagnosis of pregnancy.
Only three signs confirm pregnancy: fetal heart tones heard by examiner, fetal movement felt by examiner, or fetus visualized on ultrasound.
Goodell's Sign
Example
Cervix feels like the lips (soft) instead of the tip of the nose (firm).
Softening of the cervix in pregnancy (due to increased vascularity and oedema).
Hegar's Sign
Example
Examiner's fingers meet with little resistance when the lower segment is compressed between suprapubic and vaginal hands.
Softening of the lower uterine segment (isthmus) between the cervix and fundus; palpable by bimanual exam.
Chadwick's Sign
Example
Cervix appears deep blue or purple instead of its normal pink colour.
Bluish-violet discolouration of the cervix, vagina, and vulva due to increased vascularity.
Ballottement
Example
Tapping the lower uterus causes a fluid wave; the fetus bounces back like a cork in water.
The fetus rebounds when the lower uterine segment is tapped gently; indicates a mobile fetus.
Quickening
Example
A first-time mother feels fluttering sensations in her lower abdomen at 19 weeks.
First fetal movements felt by the mother; ~18–20 weeks in primigravidas, ~16 weeks in multiparas.
Braxton Hicks Contractions
Example
Abdomen tightens for a few seconds, then relaxes; no cervical change or progression.
Painless, irregular, practice uterine contractions beginning ~6 weeks but notable in the third trimester; not true labour.
Leukorrhea
Example
Mild white discharge increases as pregnancy progresses; caused by oestrogen and increased vascularity.
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)
Maternal Physiologic Changes by System
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
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
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.
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.
Supine Hypotensive (Vena Cava) Syndrome
Example
Pregnant woman lies flat, feels lightheaded; turn to left lateral position immediately to relieve compression.
Compression of the inferior vena cava by the gravid uterus when supine, causing dizziness, hypotension, and tachycardia.
Linea Nigra
Example
A brownish-black line becomes visible on the abdomen and fades post-delivery.
Dark vertical line from the umbilicus to the pubis, caused by increased melanin; appears in ~75% of pregnancies.
Chloasma (Melasma)
Example
Forehead and cheeks develop blotchy brown discolouration during pregnancy.
Symmetric brown patches on the face ('mask of pregnancy'), caused by oestrogen and UV exposure; may persist postpartum.
Striae Gravidarum
Example
Purple-red streaks on abdomen, breasts, and thighs appear and gradually fade to white lines.
Stretch marks from rapid skin stretching; silvery after delivery but may remain visible.
Ptyalism
Example
Woman reports difficulty swallowing; ptyalism resolves by second trimester for most.
Excess salivation in pregnancy; usually first trimester, associated with nausea.
Pica
Example
Pregnant woman craves ice or laundry starch; assess nutritional deficiency and counsel on safety.
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
Fetal Development & Milestones
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
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
Pre-embryonic Stage
Example
Zygote divides into blastocyst and implants in uterine wall by day 7–10.
Weeks 1–2; fertilisation, cleavage, and implantation; no organs yet.
Embryonic Stage
Example
Heart, brain, lungs, limbs, and GI tract form; any teratogenic exposure here causes severe defects.
Weeks 3–8; organogenesis (all major organ systems form); GREATEST teratogen vulnerability.
Fetal Stage
Example
Lungs produce surfactant, brain continues to develop, weight increases dramatically.
Week 9 to birth; growth and maturation of formed structures; organs refine, not new organ formation.
Vernix Caseosa
Example
Newborn is covered in white, cheese-like coating that washes off after delivery.
Waxy, white protective coating on fetal skin; prevents maceration from amniotic fluid.
Lanugo
Example
Preterm infant has visible fine body hair; term infant has minimal lanugo, mainly on ears and shoulders.
Fine, soft fetal hair covering the body (especially back, shoulders, ears); sheds by term or shortly after.
Surfactant
Example
L/S ratio ≥2:1 indicates mature fetal lungs; <1:5 = respiratory distress risk if born now.
Phospholipid (primarily lecithin) that reduces surface tension in alveoli, allowing lung expansion; critical for breathing after birth.
Age of Viability
Example
An extremely preterm infant born at 24 weeks has chance of survival but faces respiratory and neurologic challenges.
~24 weeks; fetus may survive outside uterus with intensive care (lung immaturity is the limiting factor).
Amniotic Fluid Volume
Example
Polyhydramnios (excess) or oligohydramnios (deficiency) are associated with fetal anomalies.
500–1,000 mL at term; protects fetus, allows movement, maintains temperature, and aids fetal lung development.
Umbilical Cord
Example
Normal cord has 2 umbilical arteries + 1 umbilical vein; SUA may indicate renal or cardiac anomalies.
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)
Estimating Due Date (Naegele's Rule & McDonald's Rule)
Formulas
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.
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
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
GTPAL / Gravida-Para Notation
Example
Woman pregnant with 1 prior term birth and 1 living child = G2 T1 P0 A0 L1.
G (gravida/total pregnancies including current) T (term births ≥37 wk) P (preterm 20–36⁶ wk) A (abortions <20 wk) L (living children).
Estimated Date of Delivery (EDD)
Example
LMP 10 August 2025 → EDD 17 May 2026 (within normal range 10 May–24 May).
Due date calculated by Naegele's rule; ranges ±2 weeks. Baby 'on due date' only ~5% of the time.
Gestational Age
Example
At LMP +280 days, gestational age is term (~40 weeks).
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
EDD = LMP − 3 months + 7 days + [1 year if LMP in Jan–Mar; −0 if Apr–Dec]
Note
Example: LMP 10 Aug 2025 → Aug − 3 = May; May 10 + 7 days = May 17; year stays 2026 → EDD 17 May 2026.
Conditions
Applies only to regular 28-day cycles; if irregular, subtract/add days for cycle length difference.
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
Ambivalence
Example
A woman excited about her pregnancy also worries about miscarriage, career impact, and motherhood — both feelings are normal.
Mixed emotions (joy + anxiety, acceptance + uncertainty) common especially in the first trimester, even in wanted pregnancies.
Introspection
Example
Pregnant woman becomes more reflective, daydreams about the baby, reviews her own childhood experiences.
Turning inward psychologically; common in second trimester as woman bonds with the fetus.
Binding-In (Attachment)
Example
Woman talks to baby, plans nursery, and feels protective toward the pregnancy.
Psychological attachment to the fetus; accelerates after quickening and increases throughout pregnancy.
Lightening (Dropping)
Example
Pregnant woman notices easier breathing, more bladder pressure, and lower abdominal profile.
Fetal descent into the pelvis; occurs ~2–4 weeks before labour in first pregnancy, during labour in multiparas.
Nesting Instinct
Example
Woman scrubs floors, organizes nursery, buys baby items in the weeks before labour — normal and healthy.
Third-trimester urge to prepare home and gather supplies; psychological preparation for labour and newborn arrival.
Couvade Syndrome
Example
Husband develops morning sickness, breast tenderness, or weight gain along with pregnant wife.
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
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
Hyperemesis Gravidarum
Example
Woman unable to keep down food/fluids; loses >5% pre-pregnancy weight; may need hospital admission.
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
Prenatal Danger Signs (Teach Every Pregnant Woman)
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
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
Preterm Labour
Example
Woman at 34 weeks reports regular contractions every 5 minutes; cervical exam shows 2 cm dilation — notify provider immediately.
Regular uterine contractions with cervical change before 37 weeks; threatens fetal viability and neonatal outcomes.
Placental Abruption
Example
Woman at 35 weeks with sudden severe abdominal pain and vaginal bleeding; fundus is irritable; monitor for signs of shock.
Premature separation of placenta from uterine wall; presents with vaginal bleeding, abdominal pain, and shock.
Placenta Previa
Example
Woman with intermittent painless vaginal bleeding; ultrasound confirms placenta over cervix; bed rest and pelvic rest advised.
Placenta covers internal cervical os; causes painless vaginal bleeding; diagnosed by ultrasound.
Pre-eclampsia
Example
Woman at 32 weeks: BP 158/98 mmHg, severe frontal headache, visual spots, RUQ pain; suspect pre-eclampsia; emergency referral.
Gestational hypertension (≥140/90 mmHg) + proteinuria and/or signs of end-organ dysfunction (headache, vision, epigastric pain, thrombocytopenia).
Eclampsia
Example
Woman with pre-eclampsia develops tonic-clonic seizure; manage airway, administer magnesium sulfate IV, call for emergency delivery.
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
Nursing Assessment & Management (Core Competencies)
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
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
Leopold's Manoeuvres
Example
1st manoeuvre = identify fundus contents (head vs buttocks); 2nd = locate back/extremities; 3rd = confirm presentation; 4th = assess engagement.
Four-part abdominal palpation technique to determine fetal position, presentation, and engagement; performed after 20 weeks.
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.
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
Presumptive vs Probable vs Positive Signs of Pregnancy
| Sign Category | Reliability | Felt by Mother? | Examples | Key Limitation |
|---|---|---|---|---|
| Presumptive | Least reliable | Yes, subjective | Amenorrhoea, nausea, breast tenderness, urinary frequency, fatigue, quickening | Each has other non-pregnant causes |
| Probable | 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 |
| Positive (Diagnostic) | Definitive | Examiner detects, not mother | FHT heard by Doppler/fetoscope, examiner-felt fetal movement, fetus on ultrasound | None — these confirm pregnancy 100% |
Maternal Cardiovascular & Haematologic Changes
| Parameter | Change | Timing | Clinical Significance | Nursing Action |
|---|---|---|---|---|
| Blood Volume | ↑ 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 |
| Cardiac Output | ↑ 30–50% | Throughout pregnancy | Compensates for increased metabolic demand | Monitor for cardiac complications in women with heart disease |
| Heart Rate | ↑ 10–15 bpm | Gradual throughout | Normal adaptation; tachycardia >100 may indicate infection/anaemia | Distinguish normal from pathologic tachycardia; assess for symptoms |
| Blood Pressure | 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 |
| Coagulation Factors | ↑ (hypercoagulability) | Throughout pregnancy | Protective at delivery but ↑ VTE risk | Screen for thrombosis risk; counsel on DVT/PE prevention (leg elevation, movement) |
Stages of Fetal Development
| Stage | Duration | Key Events | Teratogen Vulnerability | Clinical Implication |
|---|---|---|---|---|
| Pre-embryonic | 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 |
| Embryonic | Weeks 3–8 | Organogenesis; ALL major organ systems form | GREATEST vulnerability | Most critical period; avoid ALL teratogens (drugs, alcohol, infection, radiation, X-rays) |
| Fetal | 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 |
First vs Second vs Third Trimester — Psychological Characteristics
| Trimester | Emotional Focus | Key Psychological Task | Nursing Teaching Emphasis | Red Flag to Screen |
|---|---|---|---|---|
| First (0–12 weeks) | 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 |
| Second (13–27 weeks) | 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 |
| Third (28–40+ weeks) | 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 |
Naegele's Rule vs McDonald's Rule — When to Use Each
| Estimation Method | Application | Accuracy | Requirements | Watch Out | |
|---|---|---|---|---|---|
| Naegele's Rule | 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 |
| McDonald's Rule | 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 |
Pre-eclampsia Warning Signs: Which are SEVERE?
| Sign/Symptom | Pre-eclampsia (without severe features) | Severe Pre-eclampsia / HELLP | Eclampsia | Immediate Action |
|---|---|---|---|---|
| BP | ≥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 |
| Headache | Mild | Severe, frontal, unrelieved by OTC meds | May precede seizure | Immediate notification; assess vision, reflexes, assess for seizure prodrome |
| Visual Changes | Blurred vision | Severe (scotomata, photopsia, temporary blindness) | May precede seizure | Same as severe; prepare for emergent delivery |
| Abdominal Pain | None or mild epigastric discomfort | Severe RUQ or epigastric pain (HELLP sign) | May accompany convulsion | Assess for HELLP; consider delivery; monitor for liver rupture |
| Seizures | Absent | Absent | 1 or more tonic-clonic convulsions | EMERGENCY: Airway, magnesium sulfate IV, prepare for immediate delivery |
Diagrams
Normal Pregnancy: Physiologic & Psychological Changes Overview
Comprehensive mind map showing the five major domains of normal pregnancy: signs (presumptive/probable/positive), physiologic adaptations by system, fetal development milestones, methods of dating pregnancy, psychological/emotional progression by trimester, and critical danger signs to teach.
Naegele's Rule Step-by-Step Calculation
Step-by-step flowchart for Naegele's rule calculation, emphasizing the critical year adjustment that is a common NLE test error. Includes a worked example with LMP Aug 2025 → EDD May 2026.
Pre-eclampsia: Assessment & Emergency Response
Decision tree for pre-eclampsia assessment leading to differentiation of severity and appropriate emergency response, culminating in eclampsia as the most urgent obstetric emergency.
Trimester-Based Psychological Progression
Sequence diagram showing the emotional and psychological journey across the three trimesters, illustrating the progression from ambivalence to acceptance to preparation.
Fetal Development Milestones & Critical Periods
Chronological timeline of critical fetal development milestones from fertilisation through term, highlighting the embryonic period (3-8 weeks) as the critical teratogenic window and key developmental events like heart beat, organogenesis, viability, and surfactant production.
Fundal Height Assessment (McDonald's Rule) & Landmarks
Flowchart showing McDonald's rule application, landmark heights at key gestational ages, and when the rule is valid (20-36 weeks) versus invalid, with assessment of discrepancies.