Antenatal Assessment & Care Flashcards
5 purposes of Prenatal Care
-Assess health status of mothers & fetus
-Monitor progress of pregnancy
-Early detection of at-risk mothers/ fetuses
-Promote self-care of pregnant women
-Provide holistic care to pregnant women & family members
how do you calculate Expected Date of Confinement (EDC)/ Delivery (EDD)?
What is the name of rule & any limitations?
EDC=LMP - 3 months + 7 days
Nagele’s rule
only accurate for women with 28 days cycle
What is the difference between Gravidity & parity?
Gravidity: no. of times a woman has been pregnant
Parity: no. of times a woman has given birth (alive/ dead), excluding abortions
ps 1st baby stillbirth –> G1P0+1
What is the use of fundal height?
important landmarks in assessing gestation:
To estimate period of gestation
symphysis pubis: 12 weeks
umbilicus: 20 weeks
xiphisternum: 36 weeks
Name of abdominal palpation technique
Leopold’s Maneuvers
(4 maneuvers in total)
Fetal heart rate normal range
110-160/ min, regular
What instruments are used for auscultation? Best position to hear fetal heart beat?
Doppler: 8-17 weeks
Fetal Stethoscope: 17-19 weeks
best heard at fetal spine near scapula
types of lab tests for vaginal examination
- vaginal & rectal swab culture for grpB streptococcus
- pap smear for cervical cytology
- culture as indicated
What are the things to observe at the cervix during vaginal examination?
- open or close? (1st time moms: oval shape; otherwise slit)
- thicken
- bluish discolouration (Chadwick’s sign)
- increased mucus
- any abnormal discharge/ bleeding
Describe bimanual examination & possible results
Lubricate index & middle finger, enter with palm facing sideways then rotate so it is facing upwards;
Move along the posterior wall of the vagina and locate the cervix and feel for smoothness, clots, mobility and firmness
Place fingers in the posterior fornix to lift the uterus whilst simultaneously pushing the fundus down by placing the left hand above the symphysis pubis.
for early pregnancy: softening of cervix (Goodell’s sign), softening of isthmus (Hegar’s sign)
List out 7 blood tests in antenatal assessment
CBC, ABO grouping, Rhesus factor (Rh), Rubella antibody, HepB surface antigen (HbsAg), Venereal disease (syphilis), Human Immunodeficiency Virus (HIV) antibody
antenatal urine tests are for?
glycosuria
proteinuria
ketone
What to do if anti-Rh antibodies is tested positive?
give Rh anti-D immunoglobulin injection (Rogan) within 12hrs after delivery
(prevents hemolysis in baby)
5 prenatal diagnosis for congenital abnormalities/ heredity condition
Biochemical screening
amniocentesis
chorionic villus sampling (CVS)
cordocentesis
fetoscopy
what is nuchal translucency
measure thickness of subcu translucency between skin & soft tissue overlying cervical spine
if increase in thickness (1tri: >3mm, 2tri: >6mm) –> Down’s syndrome
1st tier non invasive screening test
1tri combined screening: maternal age, gestation, history of T21, nuchal translucency, PAPPA, free beta hCG
11-13 weeks; result in 2 weeks; 80-90% detection rate
2tri biochemical screening: biochemical marker: hCG, alpha-fetalprotein (AFP)
16-19 weeks; result in 2 weeks; 80% detection rate
2nd tier non-invasive prenatal test (NIPT)
DNAtest of fetal chromosomal abnormalities eg trisomy 21 (Down). trisomy 18 (Edwards), trisomy 13 (Patau)
>10 weeks; result in 1 week; 90-99%
Prenatal invasive diagnostic procedures (x3)
Chorionic villus sampling (CVS) –> chromosome, metabolic disorders ~11-13weeks
Amniocentesis –> AFP, Chromosome ~16-20weeks
Cordocentesis –> Chromosome, pH, anemia, infection, metabolic disorders 18-24 weeks
Abortion definition
expulsion of the fetus either spontaneously or by induction
<24wks or weight <500g
10-15% abortion rates (reason unknown)
Nursing care for threatened abortion
- assess amount of bleeding (if
increase & become bright red –> inevitable abortion) - advice high fiber diet to prevent constipation
2 reasons to consider TOP
1 continuing pregnancy would risk life/ injury to the woman > than termination
2 child would suffer from physical/ mental abnormalities
common med used in legal abortion; complications
mifepristone, misoprostol
bleeding, uterine cramping, n&v, headache, dizziness
antepartum hemorrhage def
bleeding from genital tract after 28 wk of pregnancy
common cause of antepartum hemorrhage
placenta praevia, abruptio, placenta, marginal hemorrhage, rupture of vasa praevia (fetal blood vessel lies over internal cervical os)
determine 4 types of placenta praevia
I: minor/ low-lying placenta
II: marginal praevia (not covering internal os)
III: partial praevia (overlie os when closed, not completely when dilated)
IV: total praevia
abruptio placenta def
bleeding from premature separation of whole/ part of a normally situated placenta from 34 week of pregnancy
3 types of abruptio placenta
mild - minimal vaginal bleeding & changes in maternal vital signs; no fetal distress/ shock
moderate - concealed/ apparent bleeding, fetal distress, tense uterus & painful palpation
severe - maternal hypovolemic shock, may lead to fetal death
difference in clinical features between placentia praevia & abruptio placenta
placenta praevia - uterus soft, tender
abruptio placenta - uterus hard, tense & tender; difficult to palpate fetal parts/ auscultate heart
Gestational DM diagnosis (test & result)
Oral Glucose Tolerance Test (OGTT)
Fasting - 5.1
1 hr - 10
2 hr - 8.5
diet control for GDM
30 kcal/ kg/ day
carb: protein: fat - 40-45%: 12-20%: 35-40%
high complex carb, adequate fibre
med & monitoring of GDM
metformin (oral), insulin
monitor: blood sugar series, HbA1c, hstix
GDM fetal complications
congenital anomalies, macrosomia, birth trauma, shoulder dystocia, neonatal jaundice,
hypertension diagnosis
140/90 on 2 occasions (>4hrs apart) or 160/110
Proteinuria diagnosis
dipstick analysis >= 1+
spot urine protein to creatinine ratio >30mg/mmol
24hrs urine: protein >300mg/ 24hrs
what is pre-eclampsia & eclampsia
pre: proteinuria +- pathological edema
eclampsia: above w/ convulsion
complications of hypertension in pregnancy
eclamptic seizure, cerebral hemorrhage, pulmonary edema, renal failure, liver hemorrhage/ failure (HELLP syndrome), thrombocytopenia, disseminated intravascular coagulopathy (DIC), APH
explain HELLP syndrome
Haemolysis, Elevated Liver enzymes, Low Platelet count
