Antepartal Period Flashcards
Presumptive Signs of Pregnancy
Woman notices/experiences, indicates to her that she’s pregnant
Maternal physiologic changes
Missed menses
N/V
Breast tenderness
Fatigue
Ptyalism ( excessive secrition of saliva)
Skin pigmentation changes
Probable Signs of Pregnancy
Maternal anatomic & physiologic changes, detected and documented by examiner
Enlargement of uterus ( pregnant vs fibroid tumor)
Chadwick’s sign - blue cervix, vagina and labia ( pregnant vs cancer)
? Fetal movement
Positive Signs of Pregnancy
Detected & documented by an examiner, but can only be attributed to fetus
- Ultrasound
- X-ray
- Fetal heart tones
- ? Fetal movement
Pregnancy Tests
Always used with Hx & PE
BhCG (Beta sub-unit of Human Chorionic Gonadotropin)
Blood or urine
Reliable
Low cost
Readily available
BhCG only during pregnancy
Low levels after fertilization; increase with implantation
Predictable rise, peaking at 60-70 days
Qualitative BhCG
“quality” of being pregnant
Urine test
Non-invasive
Accurate
Cheap
Readily available
Serum test
Rarely needed
Quantitative BhCG
Amount or “quantity”
Serum tests
Generally, high-risk only
Predictable rise of hCG
Pregnancy Tests = Probable Signs
False positives
- Cross-reaction with LH
- Misread
- Protein or blood in urine (UTI)
- Marijuana use
- Aldomet use ( antihypertensive)
- Antidepressant use
- Tumors (ovary, breast, melanoma)
Pregnancy Tests = Probable Signs
False negatives
- Impending abortion
- Misread
- Medications
- Ectopic pregnancy
- Too early/late in pregnancy
- Urine stored improperly
- Urine too dilute
Antepartal Care ( 14 prenatal visits )
Every 4 weeks until 28 weeks
Every 2 weeks until 36 weeks
Weekly until delivery
Modify prn
Trisomy
type of polysomy in which there are three instances of a particular chromosome, instead of the normal two.
E: trisomy 21 - Down syndrome
History-Taking & Assessment
All pertinent areas: past, present, potential
Consider physical appearance; verbal & non-verbal communication
_“Why are you here today?” _
(abortion ?)
History: Personal Characteristics
- Name, address, phone number - track down and find out why she never came back ;
- D.O.B. - Risk factors !!!
Adolescents
~ PIH ( pregnncy induced hypertension) , C/S, STDs, preemies, LBW ( starve themselves - hiding pregnancy) , anemia (unhealthy diet) , domestic violence
**Mature gravidas (35+) * turns 35 on the date of delivery **
~ PIH, C/S, trisomies ( Offer genetic caunseling !!! lawsuit for Wrongful Life), chronic health conditions
3.Marital status
family support, sexual practices, stress factors - Race/ethnicity/religion - African-American; Mediterranean sea countries - cickle cell anemia testing
- Education
- Occupation
History: FOB (Father of Baby)
- Age
- Height/weight
- Race/ethnicity/religion
- Education
- Occupation
- Current health status
- Significant medical history - Self & family - as far as grandparents
- Use of licit or illicit substances
- Blood type & Rh ( M -) + (D+) = (B +)
- Response to pregnancy
History: Current Pregnancy
- LMP
Any bleeding since? - Presumptive signs?
- Pregnancy test done?
- Response/adaptation to pregnancy
Establish EDC by LMP
- EDC wheel ( first day of your last menstrual period)
- Nagele’s Rule:
LMP -3 months + 7 days
Example: April 20
Minus 3 mo. = January
Add 7 days = 27
EDC January 27
Establish EDC by Ultrasound (US)
- CR length (crown-rump)
- *Most accurate method**
- 7 – 13 weeks’ only*
Establish EDC by US
BPD (biparietal diameter)
After 13 weeks’ gestation
Earlier is better
16-18 weeks’: +/- 7 days
End of preg.: +/- 4 weeks
Femur length comparison
History: Past Obstetric Data
Year of each previous pregnancy
Gestational age at outcome
Abortion, preterm, term, stillborn
Length of labor
Type of delivery
Gender, weight
Neonate’s health status
AP, IP, PP complications?
Parity: TPAL
- Term: 38 weeks’ gestation +
- Preterm: 20-37 completed weeks’
- Abortion: any pregnancy that ended prior to 20 weeks’ gestation
- Living: alive today (not just born alive)
History: Current Medical Data
Perception of current health status
Height, weight, vital signs
Blood type & Rh?
Current acute or chronic conditions
Allergies ( anesthetic agents)
Exposure to communicable disease or colds/flu since pregnant
Exposure to teratogens - N1: Alcohol since pregnant
Eating patterns ( Anorexia nervosa & Bulimia nervosa)
Exercise routines
Use of licit or illicit substances
History: Past Medical Data
Childhood diseases
Immunizations
Hospitalizations
Surgeries
Blood transfusions
Onset/treatment: anemia, asthma, blood dyscrasias, Ca, CVD, DM, endocrine disorders,
HPN, psychiatric disorders ( take meds) , renal or UT diseases ( UTI - pyelonephritis - preterm delivery) , TB ( cannot take TB drugs)
History: Family Medical Data
Both sides; back to grandparents
If deceased, note cause of death
Ca, cardiopulmonary diseases, pregnancy complications, congenital anomalies, DM, HPN,
psychiatric disorders, renal disease, TB, vascular disease
Operative deliveries - forceps delivery