Antepartal Care

Question 1

What are Presumptive signs of pregnancy and list some:

Answer 1

changes that are experienced by the woman that make her think that she may be pregnant. may be subjective symptoms or objective signs.
• Amenorrhea
• Fatigue
• Nausea & vomiting
• Urinary frequency
• Breast changes - Darkened areola, enlarged Montgomery’s tubules
• Quickening - slight fluttering movements of the fetus felt by a woman, usually between 16 to 20 weeks of gestation.
• Uterine enlargement
• Linea nigra
• Chloasma (mask of pregnancy)
• Striae gravidarum

Question 2

Probable signs of pregnancy

Answer 2

changes that make the examiner suspect a woman is pregnant (primarily related to physical changes of the uterus).

• Abdominal enlargement related to changes in uterine size, shape, position
• Goodell’s sign - softening of cervical tip
• Ballottement - rebound of unengaged fetus
• Cervical changes
• Hegar’s sign - softening and compressibility of lower uterus
• Chadwick’s sign - deepened violet-bluish color of vaginal mucosa secondary to increased vascularity of the area
• Braxton Hicks contractions - false contractions, painless, irregular, usually relieved by walking.
• Positive pregnancy test
• Fetal outline felt by examiner

Question 3

What are positive signs of pregnancy

Answer 3

signs that can only be explained by pregnancy.

• Fetal heart sounds
• Visualization of fetus by ultrasound
• Fetal movement palpated by an experienced examiner

Question 4

How early can a Pregnancy test be done?

Answer 4

Serum test: HCG can be detected 6 to 11 days

urine test: 26 days in urine after conception following implantation.

Tests provide an accurate assessment for the presence of human chorionic gonadotropin (HCG).

Question 5

HCG levels during normal pregnancy

Answer 5

Production of HCG begins with implantation, peaks at about 60 to 70 days of gestation,
then declines until around 80 days of pregnancy, when it begins to gradually increase until term.

Question 6

What would abnormal levels of HCG mean?

Answer 6

Higher levels of HCG can indicate multifetal pregnancy, ectopic pregnancy, hydatidiform mole (gestational trophoblastic disease), or a genetic abnormality such as Down syndrome.

Lower blood levels of HCG may suggest a miscarriage or ectopic pregnancy.

Question 7

Calculating Delivery Date

Answer 7

NAGELE’S RULE - take the first day of the woman’s last menstrual cycle, subtract 3 months, then add 7 days and 1 year. Remember how many days there are in each particular month when adding 7 days. November 21 minus 3 months is August 21; add 7 days = EDB is August 28

MCDONALD’S METHOD - measure uterine fundal height in centimeters from the symphysis pubis to the top of the uterine fundus (between 18 to 30 weeks of gestation).
Estimate gestational age to be equal to that of the fundal height.

Question 8

What is gravidity?

Answer 8

number of pregnancies.
Would include the current pregnancy.
Doesn’t matter if baby survived or how long she was pregnant.

Twins would count as one pregnancy.

Question 9

List some gravidity terminology

Answer 9

o Nulligravida - a woman who has never been pregnant.

o Primigravida - a woman in her first pregnancy.

o Multigravida - a woman who has had two or more pregnancies.

o Parity - number of pregnancies in which the fetus or fetuses reach viability(approximately 20 to 24 weeks or fetal weight of more than 500 g [2 lb]) regardless of whether the fetus is born alive or not.

• Nullipara - no pregnancy beyond the stage of viability.
• Primipara - has completed one pregnancy to stage of viability.
• Multipara - has completed two or more pregnancies to stage of viability.

Question 10

GTPAL ACRONYM

Answer 10

o Gravidity

o Term births (38 weeks or more)

o Preterm births (from viability up to 37 weeks)

o Abortions/miscarriages (prior to viability)

o Living children

Question 11

Changes in cardiovascular and respiratory systems of pregnant woman

Answer 11

• Cardiovascular - cardiac output and blood volume increase (45% to 50% at term) to meet the greater metabolic needs. Heart rate increases during pregnancy.
• Respiratory - maternal oxygen needs increase. During the last trimester, the size of the chest may enlarge, allowing for lung expansion, as the uterus pushes upward. Increased respiratory rate and decreased total lung capacity.

Question 12

Changes to renal system in pregnancy

Answer 12

• Renal - nitration rate increases during pregnancy secondary to the influence of pregnancy hormones and an increase in blood volume and metabolic demands.

The amount of urine produced remains the same.

Urinary frequency is common during pregnancy.

Question 13

Chloasma:

Linea nigra:

Striae gravidarum:

Answer 13

• Chloasma - mask of pregnancy (pigmentation increases on the face)
• Linea nigra - dark line of pigmentation from the umbilicus extending to the pubic area
• Striae gravidarum - stretch marks most notably found on the abdomen & thighs

Question 14

When/ how to hear FHR?

Answer 14

FHR can be heard by Doppler at 10 to 12 weeks of gestation or heard with an ultrasound stethoscope at 16 to 20 weeks of gestation.
Listen at the midline, right above the symphysis pubis, by holding the stethoscope firmly on the abdomen.

Question 15

Start measuring fundal height:

Answer 15

after 12 weeks of gestation.
Between 18 and 30 weeks of gestation, the fundal height measured in centimeters should equal the week of gestation.
Have the client empty bladder and measure from the level of the symphysis pubis to the upper border of the fundus.

Question 16

Begin assessing for fetal movement:

Answer 16

between 16 and 20 weeks of gestation.

Question 17

When to administer Rh0 (D) immune globulin (RhoGAM) IM?

Answer 17

around 28 weeks of gestation for clients who are Rh-negative.

Question 18

Why is it so important to teach increasing the intake of foods high in folic acid in pregnancy?

And list foods with folic acid

Answer 18

crucial for neurological development and the prevention of neural tube defects.
Foods high in folic acid include leafy vegetables, dried peas, beans, seeds, orange juice. Breads, cereals, other grains are fortified with folic acid.
Increased intake of folic acid should be encouraged for clients who wish to become pregnant. It is recommended that 600 mcg of folic acid should be taken during pregnancy. Current recommendations for clients who are lactating include consuming 500 mcg of folic acid.

Question 19

Maternal phenylketonuria (PKU):

Answer 19

maternal genetic disease in which high levels of phenylalanine pose danger to the fetus.

• It is important for the female client to resume the PKU diet for at least 3 months prior to pregnancy and continue the diet throughout pregnancy.
• The diet should include foods that are low in phenylalanine. Foods high in protein, such as fish, poultry, meat, eggs, nuts, and dairy products, must be avoided due to high phenylalanine levels.
• The client’s blood phenylalanine levels should be monitored during pregnancy.
• These interventions will prevent fetal complications such as mental retardation and behavioral problems.

Question 20

TORCH INFECTION – Infectious diseases in the TORCH group are those identified as causing serious harm to the embryo/fetus. These are:

Answer 20

o Toxoplasmosis – protozoan Toxoplasma gondii – devastating to immunosuppressed person can profoundly affect the fetus. Contracted by poorly cooked meat, unpasteurized goat’s milk, contact with feces of infected cats. In US approx. 40-50% of adults have antibodies to this organism. In Paris >80% of women of childbearing age have antibodies to this.

o Other Agents- HIV, fifth disease, syphilis, and varicella zoster virus.

o Rubella – (german measles) effects on fetus and newborn are great if maternal infection occurs during the 1 st 5 months of pregnancy 80-90% of fetuses exposed will be affected resulting in spontaneous abortion or serious abnormalities – heart damage, cataracts, and mental retardation. Up to 20% of childbearing age ♀ not immune. Avoid pregnancy for 3 months after immunization.

o Cytomegalovirus – herpes simplex virus group – causes congenital and acquired disorders –transmitted by asymptomatic ♀ across the placenta or cervical route during birth – may be fatal to fetus – 20-30% mortality rate for symptomatic infants and 90% of survivors have Neurologic complications.

o Herpes simplex virus – Primary infection can increase risk of spontaneous abortion in 1 st trimester. Preterm labor, intrauterine growth restriction & neonatal infection are greater risks if primary infection occurs late in 2 nd or early 3 rd .

Question 21

How would Magnesium sulfate (MgSO 4) be used in pregnancy?

Answer 21

CNS depressant halts premature labor.

o Preterm Labor-
o Pre-Eclampsia –
Contraindicated in diagnosis of maternal myasthenia gravis; relative contraindication is myocardial damage or hear block, renal function impairment.

Question 22

Maternal serum AFP

Answer 22

is a screening tool used to detect neural tube defects. Clients with abnormal findings should be referred for a quad marker screening, genetic counseling, ultrasound, an amniocentesis.

High levels may indicate a neural tube defect or open abdominal defect.

Lower levels may indicate Down syndrome

Question 23

Alpha-fetoprotein (AFP) tests for what?

Answer 23

The Alpha-fetoprotein (AFP) is a maternal blood test that screens for possible neural tube defects (the most common anomaly) in fetuses of a client with diabetes. It can also indicate the presence of Down syndrome.

Question 24

What can be found with analysis of amniotic fluid from amniocentesis

Answer 24

gender

Question 25

What can cause Late decelerations?

Answer 25

Late decelerations are indicative of uteroplacental insufficiency, and tachycardia can be a sign of hypoxia as well. Answer: 1. Fetal sleep can manifest as minimal variability—but this fetus also has tachycardia and late decelerations, which are not associated with fetal sleep. 2. Umbilical cord compression is manifested by variable decelerations, not late decelerations or tachycardia. 3. Head compressions are early decelerations that mirror the contractions, not late decelerations or tachycardia. Picture the fetal heart tracing and the physiology behind each of the patterns. Evaluate a fetal heart rate tracing the same way every time: baseline, variability, accelerations, and finally, decelerations.

Question 26

What is parity?

Answer 26

Number of times a woman has birthed a baby.

This includes babies born alive or stillborn at 20 weeks or greater.

Twins would count as one pregnancy.

Question 27

Difference between gravidity and parity

Answer 27

Gravida or gravidity describes the total number of confirmed pregnancies that a woman has had, regardless of the outcome. Para or parity is defined as the number of births that a woman has had after 20 weeks gestation.

Question 28

What is magnesium sulfate used for?

Answer 28

Prevent seizures

Prevent preeclampsia