📚 Reading: ch. 10 · ATI ch. 3–4 — confirmed by the M3 reading guide
💡 The one idea
Pregnancy signs come in three levels of certainty, and the exam wants to know you can
tell them apart. Only signs that come from the fetus itself are positive.
Level
Means
Examples
Presumptive
What she feels — subjective
Amenorrhoea, nausea, fatigue, breast tenderness, quickening
Fetal heart tones, visualization on ultrasound, examiner palpates fetal movement
🖼️ Discomforts of pregnancy, and the ones that are not.Swipe it sideways if it is cut off, or tap to open it full size.
🚨 The trap
A positive pregnancy test is only PROBABLE, not positive.
hCG can be raised by hydatidiform mole and some tumors. Only evidence of the fetus itself
— heartbeat, ultrasound, palpated movement — is a positive sign.
⭐ GTPAL, decoded
G — Gravida: total pregnancies, including the current one
T — Term births, 37 weeks and beyond
P — Preterm births, 20 to 36+6
A — Abortions, losses before 20 weeks
L — Living children now
Twins count as ONE pregnancy and ONE birth, but TWO living children.
That single fact is the most commonly missed part.
📅 Nägele’s rule
LMP − 3 months + 7 days + 1 yearExample: LMP 10 May 2025 → minus 3 months = 10 February → plus 7 days =
17 February 2026.
It assumes a regular 28-day cycle, so it is an estimate, not a promise.
Positive (the fetus is proven): audible fetal heart tones, fetal movement felt by the examiner, ultrasound visualization.
Cardiac output rises 25–50%; plasma volume rises 40–50% → physiologic anemia of pregnancy, which is dilutional, not a deficiency.
Target fluid intake about 12 cups (3 L) daily. Moderate sodium rather than eliminating it.
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Supine hypotensive syndrome: turn her to the LEFT lateral position. Elevate the legs for faintness. Never supine in late pregnancy — vena cava compression.
Normal as-expected skin changes: melasma, linea nigra, striae gravidarum, Montgomery tubercles.
📕 From your ATI review book
Covered by ch. 3 · ch. 4 (discomforts, danger signs).
Parity counts pregnancies reaching 20 weeks, not babies. Twins delivered at term = para 1. A stillbirth still counts.
ACOG term definitions: early term 37 0/7–38 6/7 · full term 39 0/7–40 6/7 · late term 41 0/7–41 6/7 · post-term ≥42 0/7. Periviable is roughly 20 0/7–25 6/7.
Fundal landmarks: just above the symphysis at 12 weeks, midway to the umbilicus at 16, at the xiphoid by 36.
Blood pressure trends DOWN in the first two trimesters and returns to baseline at term — so hypotension in the third trimester is unexpected. Pulse rises 10–15/min by ~32 weeks. The diaphragm displaces up to 4 cm.
Ambivalence early in pregnancy is normal and usually resolves before the third trimester. It does not mean she is rejecting the pregnancy.
Only three positive signs: audible fetal heart, fetus on ultrasound, fetal movement palpated by a clinician.
📚 From your Maternal & Child textbook
Pillitteri, Maternal and Child Health Nursing — ch. 10 (physiologic and psychologic changes) · ch. 13 (nutrition).
The diaphragm is displaced upward by up to 4 cm, so mild breathlessness on exertion late in pregnancy is expected. Dyspnea at rest, or a sudden change, is not.
Blood pressure falls through the first two trimesters and returns to baseline at term — so hypotension in the third trimester is the unexpected finding, not the reassuring one.
Ambivalence early in pregnancy is normal and usually resolves before the third trimester. It is not rejection of the pregnancy.
⚠️ Exam traps
Only the three positive signs prove a fetus exists. Presumptive / probable / positive is asked every term.
Physiologic anemia is dilution. Do not treat it like iron deficiency without labs.
🧠 Mind maps 1
One per disorder, built from the structure of your ATI chapter.
ATI Active Learning Template — System DisorderExpected Physiological Changes During Pregnancy
Filled from ATI chapter 3, row by row from that chapter’s own sections — 12 of 12 rows have content.
9 rows came from outside your ATI chapter — 2 cite a source, 7 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Explains presumptive, probable, and positive signs of pregnancy, hCG-based confirmation testing, dating tools like Naegele's rule and GTPAL, and expected changes across body systems, vital signs, and body image during gestation.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Prenatal visits: monthly to 28 weeks, every 2 weeks to 36, then weekly.
Folic acid 400–800 mcg daily; 4 mg with a previous neural tube defect.
Influenza vaccine in any trimester and Tdap at 27–36 weeks for the baby’s passive immunity.
No live vaccines in pregnancy — MMR and varicella wait until postpartum.
No alcohol, no smoking, no unprescribed drugs. There is no known safe amount of alcohol.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
From this module — built from the notes above on this page, not a section of the ATI chapter.
Age under 17 or over 35; short interval since the last birth.
FHR baseline runs 110 to 160/min; accelerations signal an intact fetal CNS.
Cardiac hypertrophy develops from rising blood volume and cardiac output, resolving after birth.
Fundal height: palpable above symphysis by 12 wk, between umbilicus/symphysis by 16 wk, near xiphoid by 36 wk.
Chadwick sign: cervix and vagina turn purplish-blue, and the cervix noticeably softens.
Breasts enlarge and areolas darken due to pregnancy hormones.
Melasma (chloasma): facial hyperpigmentation across the nose, cheeks, or forehead.
Linea nigra: dark vertical line from umbilicus to pubic area.
Striae gravidarum: stretch marks appearing on the belly, thighs, hips, buttocks, and chest.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not in your ATI chapter — filled from StatPearls, 2024.
Red blood cell mass rises roughly 30% in pregnancy, but plasma volume expands even more, producing physiologic dilutional anemia.
Clotting factors VII, VIII, X, XII, von Willebrand factor, and fibrinogen all increase, creating a hypercoagulable state.
Because of this clotting shift, a pregnant patient's DVT risk can run as much as fivefold above baseline.
Cardiac output rises about 40% over pregnancy, with a 20% increase already present by 8 weeks gestation.
StatPearls (NCBI Bookshelf) · Physiology, Maternal Changes · open the source →
Diagnostic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Ultrasound to date the pregnancy, confirm viability, and check placental location and fetal number.
A dating scan in the first trimester is the most accurate — accuracy falls as pregnancy advances.
Anatomy scan around 18–20 weeks.
Fetal heart tones by Doppler from about 10–12 weeks; by fetoscope from about 18–20.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Acknowledge pregnancy-related concerns and let clients share feelings without judgment.
Discuss expected physiological changes and a rough timeline for returning to prepregnant status.
Help clients set postpartum goals for self-care and newborn care.
Refer to counseling if body image concerns are negatively affecting the pregnancy.
Teach about common pregnancy discomforts and remedies at prenatal visits.
Tell clients to keep all follow-up visits and report bleeding, fluid leakage, or contractions right away.
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Prenatal vitamin with iron and folic acid — take iron with vitamin C, not with milk, tea or antacids.
Acetaminophen is the usual analgesic of choice.
Avoid NSAIDs, especially after 20 weeks — ductus arteriosus and renal effects.
Calcium carbonate for heartburn; docusate for constipation.
Review every existing prescription for pregnancy safety — ACE inhibitors, ARBs, warfarin, isotretinoin and several anticonvulsants are teratogenic.
Therapeutic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Mostly supportive rather than procedural — this chapter is about normal adaptation.
Compression stockings for varicosities and dependent edema.
Left side-lying to relieve supine hypotensive syndrome, where the uterus compresses the vena cava.
Pelvic tilt and good body mechanics for back pain from the shifted center of gravity.
💬 Around the patientClient Education · Interprofessional Care
Client Education
From this module — built from the notes above on this page, not a section of the ATI chapter.
Presumptive signs are what she feels (amenorrhoea, nausea, fatigue); probable are what you observe (positive test, Goodell, Chadwick, Hegar, ballottement); positive are the fetus itself (heart tones, visualized fetus, examiner-felt movement).
Only positive signs confirm pregnancy — everything else has another explanation.
Report immediately: vaginal bleeding, leaking fluid, severe or persistent headache, visual changes, epigastric pain, decreased fetal movement, fever, painful urination.
Weight gain guided by pre-pregnancy BMI — normal BMI is about 25–35 lb total.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Obstetric provider or midwife leads care; maternal-fetal medicine for high-risk pregnancy.
Dietitian for diabetes, obesity, low weight gain, or vegetarian and restricted diets.
Social work for housing, food security, transport and safety.
Dentist — dental care is safe and important; gum disease is linked to preterm birth.
Lactation consultant and childbirth education, ideally before the third trimester.
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2024.
After about 20 weeks gestation, lying supine lets the uterus compress the inferior vena cava and aorta, dropping blood pressure.
This aortocaval compression is treated by placing the patient in the left lateral position to shift the uterus off the vessels.
Any hypotension in a third-trimester patient should be treated as abnormal and prompt evaluation for vena cava compression.
StatPearls (NCBI Bookshelf) · Aortocaval Compression Syndrome · open the source →
📋 Prenatal Care6 parts
ATI Active Learning Template — System DisorderPrenatal Care
Filled from ATI chapter 4, row by row from that chapter’s own sections — 12 of 12 rows have content.
7 rows came from outside your ATI chapter — 5 cite a source, 2 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Prenatal care uses scheduled visits, screening, and education to catch problems early and reduce maternal-fetal illness and death; most birth defects arise between weeks 2 and 8. Visits address history, physical changes, and self-care teaching throughout pregnancy.
Health Promotion & Disease Prevention
Avoid all OTC drugs, supplements, and prescription meds unless the provider approves.
Avoid tobacco and alcohol; linked to anomalies, preterm birth, and growth restriction.
Encourage moderate exercise 30-45 min/day, about 150 min/week, unless contraindicated.
Avoid hot tubs and saunas during pregnancy.
Give influenza and COVID-19 vaccines per CDC guidance; give Tdap at 27-35 weeks gestation.
Emotional lability and ambivalence about the pregnancy are normal and often resolve by the third trimester.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not in your ATI chapter — filled from NICHD.
Maternal age under 20 raises risk for pregnancy-related hypertension, anemia, preterm labor, and untreated sexually transmitted infections.
Pre-pregnancy conditions such as uncontrolled hypertension, diabetes, kidney disease, and autoimmune disorders increase pregnancy risk.
No amount of alcohol is considered safe during pregnancy, and marijuana or illegal drug use roughly doubles stillbirth risk.
NICHD · What are some factors that make a pregnancy high risk? · open the source →
Assessment — Expected Findings
From this module — built from the notes above on this page, not a section of the ATI chapter.
Fundal height in cm roughly equals gestational age in weeks from about 18–30 weeks.
Fetal heart rate 110–160/min.
Quickening at 16–20 weeks in a first pregnancy, earlier in later ones.
Blood pressure falls in the second trimester and returns to baseline by term — a rise is the abnormal finding.
Physiological anemia of pregnancy: plasma volume rises more than red cell mass, so hemoglobin dilutes.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Indirect Coombs' test repeated at 24-28 weeks gestation for Rh-negative, unsensitized clients.
CBC with differential, Hgb, and Hct detect infection and anemia.
GBS vaginal/rectal culture obtained at 36 0/7 to 37 6/7 weeks gestation.
Urine culture recommended at 12-16 weeks gestation or at the first prenatal visit.
Diagnostic Procedures
Not in your ATI chapter — filled from USPSTF, 2019; StatPearls.
Rh(D) blood typing and antibody screening are done at the first prenatal visit for every pregnant patient.
If the biological father's Rh status is unknown, an unsensitized Rh-negative patient gets a repeat antibody check around week 24 to 28.
Group B strep culture is collected as a universal screen once the pregnancy reaches roughly the 36-week to 37 6/7-week mark.
Gestational diabetes screening is recommended for all pregnant patients at 24 weeks gestation or later.
USPSTF / StatPearls · Rh(D) Incompatibility: Screening; Gestational Diabetes: Screening; Group B Streptococcus and Pregnancy · open the source →
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Perform or assist with Leopold maneuvers to check fetal presentation and position.
Assist provider with the pelvic exam and pelvic measurements to gauge birth canal fit.
Have client empty bladder and breathe deeply during pelvic exam to ease discomfort.
Give Rho(D) immune globulin IM around 26-28 weeks gestation for Rh-negative clients.
Medications
Not in your ATI chapter — filled from USPSTF, 2019; StatPearls.
Unsensitized Rh-negative patients receive a 300 microgram dose of Rh immunoglobulin after 28-week antibody testing.
A second Rh immunoglobulin dose is given within 72 hours after birth if the newborn is Rh-positive.
Patients with a positive GBS culture receive intravenous penicillin in labor: a 5-million-unit loading dose, then 2.5 to 3 million units every 4 hours.
USPSTF / StatPearls · Rh(D) Incompatibility: Screening; Group B Streptococcus and Pregnancy · open the source →
Therapeutic Procedures
Not in your ATI chapter — filled from StatPearls, 2024.
Once a pregnancy reaches 15 weeks, amniocentesis becomes an option, done with a thin needle under constant ultrasound guidance.
During amniocentesis, about 18 to 20 mL of amniotic fluid is withdrawn after the first 1-2 mL is discarded.
In experienced hands, amniocentesis carries an estimated procedure-related pregnancy loss risk around 0.1% to 0.13%.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Prenatal teaching covers health promotion, birth preparation, common discomfort relief, and danger signs to report.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Provider or midwife for the visit schedule and any deviation from it.
Ultrasonographer for dating and anatomy scans.
Laboratory for the timed screening panel — the windows matter more than the tests.
Dietitian if weight gain is outside the expected range.
Childbirth educator and lactation consultant in the second and third trimesters.
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2024.
Amniocentesis carries a 1% to 2% risk of amniotic fluid leakage, most cases resolving with reduced activity.
Vaginal bleeding occurs in about 2% to 3% of amniocentesis procedures, with infection risk under 0.1%.
About 60% of early-onset newborn GBS infections occur even after a negative screen during the recommended window.
StatPearls (NCBI Bookshelf) · Amniocentesis; Group B Streptococcus and Pregnancy · open the source →
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Cardiac output rises 25–50%; plasma volume rises 40–50% → physiologic anemia of pregnancy, which is dilutional, not a deficiency.
Target fluid intake about 12 cups (3 L) daily. Moderate sodium rather than eliminating it.
Supine hypotensive syndrome: turn her to the LEFT lateral position. Elevate the legs for faintness. Never supine in late pregnancy — vena cava compression.
Parity counts pregnancies reaching 20 weeks, not babies. Twins delivered at term = para 1. A stillbirth still counts.
ACOG term definitions: early term 37 0/7–38 6/7 · full term 39 0/7–40 6/7 · late term 41 0/7–41 6/7 · post-term ≥42 0/7. Periviable is roughly 20 0/7–25 6/7.
Fundal landmarks: just above the symphysis at 12 weeks, midway to the umbilicus at 16, at the xiphoid by 36.
Blood pressure trends DOWN in the first two trimesters and returns to baseline at term — so hypotension in the third trimester is unexpected. Pulse rises 10–15/min by ~32 weeks. The diaphragm displaces up to 4 cm.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
