antepartum 1 Flashcards
barriers to care
financial, cultural, gender, sexual orientation
EDB wheel
need LMP to be accurate
basically if you cant do math?
uterine size
start at 16 -20 weeks
auscultation
ultrasonic doppler device = 12 weeks
fetoscope = 20 weeks
preparing for parenthood
choose provider, birth setting, type of labor, sibling prep, prenatal classes, adolescent parenting classes, prep for C/S, prep for vaginal, prep for vaginal after C/S
danger s of pregnancy
absence of fetal movement, gush of fluid from vagina <37 wk, vaginal bleed, abd pain, fever, persistent v, dysuria, dizzy, blurred vision, spots before eyes, persistent HA, edema, muscular irritability or convulsions, epigastric pain, oliguria
fundal height
mcdonalds
20 - 34 wk +/- wk
IPV
intimate partner violence
increases with pregnancy
interview alone
GTPAL
gravida: total # and current
term >37 wk
preterm 20 - 36^6 wk
abortion (spontaneous <20wk)
living
+ diagnosis
fetal HR, fetal movement, visualize fetus
probable
change in pelvic organs (signs)
abd enlarge, braxton hicks, abd striae, uterine souffle, change in skin pigmentation, + test, palpate fetal outline
presumptive
amenorrhea, n/v, fatigue, urinary freq, breast change, quickening
endocrine changes
thyroid enlarge, [] of PTH increases, prolactin and oxytocin = lactation, vasopressin, increase aldosterone
metabolic changes
extra waste, fat, and P stored, fats stored more completely
supine hypotensive syndrome
lay flat, uterus will depress venacava, dropping BP, always sit up
mothers response to pregnancy
ambivalence (right time, intended, role change), acceptance, introversion, mood swings, fear, changes in body image
rubins tasks of pregnancy
ensuring safe passage
seek acceptance by others
seek commitment and acceptance of self
learn to give oneself on behalf of child
father’s response to pregnancy
confused by mood changes, feels left out, resents attention and change in their relationship, resolve conflicts about fathering, couvade
family response to pregnancy
siblings: rivalry, fear of changing parent relationships, may need reassurance
grandparents: closer relationship with expectant couple, clarify role of helping grandparent
prenatal hx
current and past pregnancies, gyno hx, current and past med hx, substance use, fam med hx, religious, spiritual, cultural, occupational hx, partner hx, social hx and pref
factors related to father’s health
fam hx, significant health problems, blood type and Rh, occupation, best learning method, attitude
psychosocial factors
hx of abuse, hx of emotional problems (depression and anx, postpartum depression), support, overuse or underuse of healthcare system, acceptance of pregnancy (intended or not), pans for care of child after birth, feeding pref
cultural/religious factors
influence expectations of childbearing experience
beliefs or practices that maintain spiritual wellbeing or influence care (blood, diet)
ASK!!
major prenatal screening tests
pap smear, CBC, hgb, rubella titer, ABO and Rh typing, hep B screen, STI, sickle cell (african or latino descent), CF, HIV, drugs, fetal chromosome anomaly, urine (protein, glucose), urine culture at 12 -16 wk, GBS
MSAFP
quad screen
high AFP = spina bifida, anencepathaly, multiple gestation, DM
low AFP = down syndrome, edwards syndrome
NIPT
cell free fetal DNA
cognitive changes
decreased attention, concentration, and memories
eye changes
decreased intraocular P, cornea thick
MS changes
pelvic joints relax, center of gravity changes (lordosis), separation of rectus abdominus
weight gain: normal = 25 - 35; over = 15 - 25; obese = 11 - 20; under = 28 - 40
skin changes
hyperpigmentation, striae, facial chloasma, vascular spider nevi, decreased hair growth, hyperactive sweat and sebaceous glands
linea nigra
urinary changes
dilation of kidneys and ureters + pressure on bladder by ureters = increased residual volume and urine stasis
increased risk for infection, increased risk for preterm labor
GI changes
n/v
softening and bleeding of gums
increase in saliva (pytalism)
c - progesterone
heartburn (pyrosis)
gallstones
hemorrhoids
cardiac changes
uterus can compress vena cava when laying down flat (later trimesters)
blood volume 40-50%, phys anemia (increase volume, rbc same, pseudoanemia), decreased systemic and pulmonary vascular resistance, increased CO, hypercoag
respiratory changes
O2 consumptions increases, subcostal angle and AP diameter increase, breathing abd -> thoracic, nasal stuffiness and epistaxis
breast changes
glandular hyperplasia AND hypertrophy
areolae darken
superficial veins prominent
striae may develop
colostrum is secreted
vaginal changes
mucosa thicken
increase in secretions, loosening of connective tissue
ovary changes
stop producing ova
secrete progesterone until week 7 to maintain endometrium (placenta takes over)
mucous plug
thick piece of mucous that blocks opening of cervix during pregnancy
uterine/cervical changes
- softening of cervix = goodells
- softening of uterus = hegar
- bluish discoloration of cervix = chadwick
uterine changes
enlargement - hypertrophy
fibrous tissue increases
increase in blood flow
braxton hicks contractions
