Antepartum Flashcards
End of Week 1
Blastocyst implants in endometrium
End of Week 4
weighs 400mg
- at greatest vulnerability to teratogens
- Blood vessels and heart form
- Neural tube is forming
End of Week 8
FHR 110-160
Iron and glycogen get stored in the liver (and for 5mos after)
-End of the embyronic period
End of Week 12
FHR can be hears w/ doppler
- sex is apparent
- movements occur
End of Week 16
Amniotic fluid is adequate for an amniocentesis
-Face looks human
End of Week 20
Quickening can now be felt
- Fetus is viable or at 500g+
- Meconium accumulates in the colon
End of week 24
weight is 600g
End of week 28
Surfactant forming on alveolar surfaces - lungs are developed but not mature
End of week 32
Bones are fully developed
End of week 36
LS ratio is 2:1 so lungs are mature
End of Week 40
weight of about 7lbs
-full term!
TORCH: Toxoplasmosis
Maternal - flu like aches, lymphadenopathy, spontaneous abortion
Fetal - LBW, congenital toxoplasmosis
TORCH: Rubella
Maternal - rash, fever, malaise, spontaneous abortion during 1st trimester
Fetal - deafness, IUGR, microcephaly
TORCH: Cytomegalovirus
Maternal - cervical discharge, flu-like symptoms
Fetal: death, hemolytic anemia, jaundice, microcephaly, hydrocephaly
TORCH: Herpes
Maternal - lesions, pain, papules, ulcers, fever, malaise, dysuria, dyspareunia
Fetal - crosses placenta and can also be giver o baby at birth
Common risks in childbearing years
- STDs
- IPV
- nutrition issues (obesity v eating disorders
- TORCH
- Cancer (hormonal)
- Economis issues
Risk factors affecting Fetus
- Alcohol
- Tobacco
- Caffeine
- Drugs
- Prescription drugs
- nutrient deficiencies
Sentinel events in OB setting
- APGAR less than 7
- Preterm labor and preterm birth
- Giving more than 3 or 4 units of blood to mom
- Placental abruption
Tocolytics for preterm labor
Magnesium Sulfate
Terbutaline
Nifedipine
Indomethacin
Glucocorticoid - assist premature infant to grow
Betamethasone
Dexamethasone
Care for Preeclapmsia
- Assess BP often
- Give magnesium sulfate + watch I&Os (125ml/hr)
- Decrease stimulation
- Assess DTRs
HELLP Syndrome
Hemolysis
Elevated Liver Enzymes
Low Platelet count
-can be caused from Preeclampsia
DIC
Blood cannot clot and patient can bleed out from everywhere
1st Trimester
wk0 - 13
2nd trimester
wk14 - 26
3rd Trimester
wk27 - 40
Warning signs during 1st Trimester
severe vomiting
- Chills, fever
- dysuria
- diarrhea
- Abd cramping
- Vaginal bleeding
Warning signs 2nd & 3rd trimesters
- Persistent, severe vomiting
- Sudden discharge of fluid from vagina < 37wks
- Vaginal bleeding
- Severe backache/flank pain
- Change in fetal movements
- Contractions; pressure; cramping < 37 wks.
- Visual disturbances
- Face/fingers/sacrum swelling
- Headaches
- Muscular a or convulsions
- Epigastric/Abd pain
- Glycosuria, + GTT reaction
Prenatal Visit Schedule
wk16 - 28: every 4 weeks
wk29 - 36: every 2 weeks
wk36 - term: every week
Post: 2x week
Emergency Situations
- uterine contractions q10 minutes or less for an hour or more
- vaginal bleeding
- fluid leaking from vagina
- odorous vaginal discharge
Ultrasound
L1: fetal viability, presentation, age, placental location, structures, AFV
L2: fetal presentation, FHT
L3: anatomically or physiologically abnormal fetus
Types of Ultrasound
Abdominal: gel is placed on abd, bladder must be full
Transvaginal: lithotomy position, determines cervical length
Non-Stress Test (NST)
Reactive: normal FHR with 2 accelerations
Nonreactive: additional testing needed
*Vibroacoustic stimulation
Contraction Stress Test (CST) or Oxytocin Contraction Test (OCT)
-FHR baseline –> you want a NEGATIVE TEST
Contractions started by nipple stimulation of pitocin
Negative: no late decelerations
Positive: late decelerations
Biophysical Profile
-Fetal breathing movements
-Gross body movement
-Fetal tone
-Qualitative amniotic Fluid volume
-Reactive non-stress test
Normal score 10:10
Amniocentesis
- *after 14 weeks + informed consent
- LS ratio
- Alpha-fetoprotein (NTDs)
- Desquamated fetal cells (genetic testing)
Complications of Amniocentesis
- infx
- injury to fetus
- leaking AF
- pregnancy loss
- maternal hemorrhage
- Rh isoimmunization
- Amniotic Fluid Embolism
- Fetal death
Nursing: Amniocentesis
- Mother empties bladder
- Monitor fetus before and for 1hr after
- watch for vaginal bleeding, leaking AF, cramping or fever
- EDUCATE
- Give expectations for mild discomfort
Chorionic Villus Sampling
- *10-13 weeks + informed consent
- genetic defects
- sample of blood and tissue taken from chorionic villi
PUBS test
kleihauer-betke test –> tests for fetal or maternal bleeding
Maternal Serum Alpha-Fetoprotein (MSAFP)
***15-20wks
elevated levels associated w/ open neural tubes
Coombs test
Screens for Rh incompatibility and detects fetal hemolytic anemia
Recommended weight gain: underweight
28-40lbs
Recommended weight gain: Normal
25-35lbs
Recommended weight gain: Overweight
15-25lbs
Recommended weight gain: Obese
11-20lbs
Recommended amount of Folic Acid for pregnancy
400mcg daily
Foods w/ folic acid in them
fortified cereals, dark green leafy veggies, oranges, broccoli, asparagus, artichokes, liver
Ductus Arteriosis
Bypasses lungs - blood flows from pulmonary arteries to the aorta
Ductus Venosus
bypasses liver from umbilical vein to the inferior vena cava
Foramen ovale
blood passes thru right atrium through the FO to the left atrium
Components of Biophysical Profile
Breathing movements Amniotic Fluid Volume Fetal Tone Heart rate reactivity Body movements
Good score for BPP
10:10 or 2 rating for each section
Diagnosis for Chlamydia
Culture or immunoassay in 1st trimester
Treatment for Chlamydia
Azithromycin
Effects of Chlamydia
PROM, PTL, ectopic pregnancy
Diagnosis of Gonorrhea
Gram stain culture
Treatment of Gonorrhea
Ceftriaxone
Effects of Gonorrhea
amnionitis, PTL
Diagnosis of Syphilis
VDRL or RPR serologies
Treatment of Syphilis
Penicillin + treat by 18th week
Effects of Syphilis
spontaneous abortion, PTL, congenital syphilis
Diagnosis of Herpes
examination and culture of lesions/ulcers
Treatment of Herpes
Acyclovir + cryotherapy
Effects of Herpes
can cross the placenta
Management: Toxoplasmosis
Blood test for titer; no cat litter; avoid uncooked meat; elective abortion if titer is too high
Management: Varicella
Immune globulin for exposed pregnant women
Management: Rubella
Rubella titer 1:8 means immune
Management: Cytomegalovirus
Therapeutic abortion if primary infection is prior to 20wks
Precipitous Labor
Labor that lasts 3 hours or less from onset of contractions to birth of the baby
Nursing interventions post ROM
- take temperature often
- count and weigh pads that mom uses
- check moms abdomen for tenderness at least q2 hours
Signs of Placenta previa
Painless bright red bleeding after 20 weeks
Signs of Placental abruption
Severe Abdominal pain, with or without bleeding
ACHES
A - abdominal pain C - Chest pain/SOB H - headaches/vascular accident/increased BP E - eye problems S - severe leg pain
BRAIDED
B: benefits
R: risks
A: alternatives
BRAIDED
B: benefits R: risks A: alternatives I: inquiries D: decisions E: explanations D: documentation
Acid - Base balance
Respiratory Alkalosis compensated by metabolic acidosis
