Antepartum Flashcards
Antepartum?
Before child birth
Also referred to as prenatal care
1st trimester?
Completion of 12 weeks
Organ, heart form
First prenatal visit should be within the first 12weeks
Lots of lab work
2nd trimester?
13 weeks to 27 weeks(3moths to 6months)
Organ develop
3rd trimester?
28 weeks to delivery (7-9months)
When is the unborn baby most at risk from teratogens?
During the embryonic stage
1st trimester
Sing of pregnancy
Subjective
= Presumptive
Symptoms, reports and experience
Fatigue, nausea
Urinary frequency
Amenorrhea
Beast change
Quickening
Sing of pregnancy
Objective
= Probable
Abdominal enlargement
Positive pregnancy test
Hegar’s sing, Chadwick sing
Ballottement
Sing of pregnancy
Diagnostic
= Positive
Urine test
Fetal heart sounds, Fetal movement
Baby can be hard, felt or seen!
Physiological change
Cardiovascular
Blood volume ↑
Cardiac output ↑
Heart rate ↑
Iron demand ↑
Plasma ↑ 50%
RBC’s demand ↑
Risk of blood clot ↑
Low BP
Normal hgb range during 1st to 3rd trimester?
1st trimester Hgb < 11.0
2nd trimester Hgb < 10.5
3rd trimester Hgb <11.0
Physiological change
Respiratory
Total lung capacity decrease(uterus enlarge) RR increase(due to O2 requirement)
What’s factors drastically impact oxygenation?
Smoking
Asthma
COVID
Physiological change
Gastrointestinal
Nauseas (hormone changes)
Constipation (elevated progesterone cause smooth muscle relax)
Gastric motility decreases
Language of OB
G
Gravida
The number of Pregnancies
Language of OB
Parity
The number of deliveries
Nullipara
Primapara
Mulitpara
Language of OB
G-T-P-A-L
T
Term # of deliveries that occurred starting from 38 weeks gestation
Language of OB
G-T-P-A-L
P
Preterm # of deliveries that occurred between 20 – 37 weeks gestation
Language of OB
G-T-P-A-L
A
Abortion # of deliveries before 20 weeks/spontaneous or elective
Language of OB
G-T-P-A-L
L
Living # of living children at the time of the interview
Clients last period was April 1st 2022.
When it will be the EDB?
January 8th,2023
She has a 4yo daughter and a 6yo son
The son was a term vaginal delivery at 39 weeks
The daughter came early at 35 weeks
She admits to having 2 abortions
GTPAL?
a)G - 5 P - 1 T - 1 A - 2 L - 2
Weight Gain
a) 1st trimester ideal gain?
b) after that?
a) 1.1 to 4.4lb
b) 1lb per week
Lacy is 135pound and she already gain 5pounds at week 14. what is the ideal range?
3.1-6.4lb
14-12=2
1st trimester range is 1.1 lb tp 4.4lb
add 2=3.1-6.4lb
What can we tell about iron pills?
They can cause constipation
Increase fluids and fiber
Best absorbed with vitamin C
Increase rich iron-food (meat, fish, liver, green leafy vege)
What can we tell about managing the morning sickness?
Crackers by the bed(dry food)
Small frequent meals
Snack before bed(avoid an empty stomach)
Avoid greasy foods
Ginger products
Notify vomiting more than once a day
What trimester is Lacey in at 16 weeks?
2nd
What is the dark line, vertically the length of her abdomen?
what is causing it?
Linea Nigra
Caused by the hormones
Lacey is 35 years old which puts her pregnancy at increased risk
What prenatal screening options do you suggest?
Quad marker Screen
What education can you provide Lacey regarding the Quad screen?
It is a Screening test
Can detect risk for Down syndrome and for neural tube defects.
Most accurate if done between 16-18 weeks.
What does a low AFP(the Alpha-fetoprotein )on Quad screen indicate?
What other test she can take?
Possible Down syndrome or other trisomy
Amniocentesis
What can you tell Lacey about amniocentesis?
Small amount of a)_________ is withdrawn from the b)______ to collect c)______
Amniocentesis is d)_______ test
There is a small risk for e______
a) amniotic fluid
b) uterus
c) fetal cells
d) diagnostic(99% accurate)
e) infection and miscarriage
What does the nurse need to do immediately after the amniocentesis?
Monitor the Fetal Heart Rate
How Preconception care important? 2
1) By the time the woman realizes she is pregnant, they already exposure to teratogen
2) General health status of the mother BEFORE pregnancy
Teratogen exposure during the what week?
The first two weeks post conception
exposure to teratogens may cause spontaneous abortion
What is the purpose of Preconception Care?
Improve pregnancy outcomes by addressing
Modifiable Risk Factors and Non-modifiable Risk Factors
What is modifiable Risk Factors?
Smoking
Alcohol
Environmental hazards
Weight
Poor nutrition
Medications
Which women especially take preconception care?
Women has history of
Spontaneous abortion
Preterm birth
Birth defect
Chronic illness(diabetes, hypertension, etc.)
Advanced maternal age (> 35 years)
What is included in Preconception Care?
Health promotion activities
Nutrition
Iron deficiency/anemia increases risk LBW infant
Folic acid supplementation PRIOR TO PREGNANCY for all women/neural tube defect
What is included in Preconception Care?
Risk Assessment
Medical history(Non-modifiable)/History of Partner & Family
Physical exam
Lab tests
Teratogen exposure (Modifiable)
Nutrition: (Modifiable) BMI
Prenatal Care purpose?
promote maternal & fetal wellbeing → improve
outcomes
First Trimester
Psychological change
0-12 weeks
Uncertainty
Ambivalence (mixed feeling)
Needs to be able to say “I am Pregnant”
Second Trimester
Psychological change
13-27 weeks
Fetus as primary focus
Sees fetus as a separate
Quicking starts
Needs to be able to say “I am going
to have a baby”
Prenatal visits for healthy, low-risk women
How often?
Monthly until week 28
Every 2 weeks until week 36
then weekly
Third Trimester
Psychological change
28-40 weeks
Vulnerability
Worry that baby may be lost or harmed
Preparation for birth
Needs to be able to say “I am going to be a parent.”
Currently 32 weeks gestation
●1st pregnancy spontaneous abortion at 16 weeks
●2nd pregnancy induced for post term; child 3 years old
●3rd pregnancy delivered at 36 weeks due to
placental abruption; infant was stillborn
GTPAL?
G_4_T_1_P_1_A_1_L_1_
Currently 36 weeks gestation
●1st 2nd pregnancies electively terminated at 10-12 weeks
●3rd pregnancy a girl delivered at 35 weeks
GTPAL?
G_4_T_0_P_1_A_2_L_1_
Amniotic Fluid function?
Protection
Temperature regulation
Maturation of lungs
GI and GU systems
Limb development
What is the promote care consist?
Teach healthy practices, self-care
Identify risk factors
Medical & psychosocial interventions
Establish EDB
Track fetal growth
When mother can feel quickening?
18-20 weeks
What consist OB visit until week 28?
Maternal assessment
Weight
BP
Urine
Changes
Fetal assessment
Fundal height
FHR
Movement
Teaching
Concerns
28 week visit, what are the lab work?
24-28 week lab work
CBC
1 hour glucose screen
Antibody screen (indirect Coombs) if Rh neg
What is the normal rang of gain weight?
BMI 18.5-29.9
25-35 pounds
After 28weeks, what are the lab work?
At 36 weeks, a group B strep culture
Education becomes more focused on preparing for delivery
What is the first trimester screens?
Nuchal translucency
The nuchal translucency test is done by ultrasound between 11-13 weeks. It measures an area in the back of the fetal neck for enlargement related to specific trisomy
If nuchal translucency is positive then?
Week 10-12
removes a small portion of the fetal side of the placenta
Chorionic Villus Sampling
Diagnostic test
Greater risk to the fetus than amniocentesis
What blood test done in week 16-18 weeks?
Quad screen test
alpha-feto-protein (MSAFP) may indicate
High neural tube defects
Low Down syndrome
What is the newest maternal blood test?
Cell-Free DNA testing
Isolates fetal cells from the mother’s circulation
Highly accurate for trisomies 13, 18 & 21
Ultrasound
1st trimester
Crown-rump measurement for dating
Nuchal translucency for genetic screening
Diagnosis of multiples
Early documentation of viability
Ultrasound
2nd trimester
Anatomy scan
Placenta location
Cervical integrity
Used to guide the needle for CVS or amniocentesis
Ultrasound
3rd trimester
Fetal growth
Amniotic fluid index
Doppler flow through umbilical cord
Placenta location
Fetal position
Component of the biophysical profile
Used to guide the needle for amniocentesis or other invasive procedure
Fetal echocardiography 2nd or 3rd trimester
Weighs 156 pounds at her 28 week visit
Her pre-pregnant weight was 136 pounds
is this normal range?
1st trimester 1.1-4.4 lbs
28week – 12week = 16 weeks
16+1.1=17.1 + 136 = 153.1
16+4.4=20.4 + 136 = 156.4
Protein
a) How many per days
b) examples
a) Three servings/ 2oz.
b) meat
fish
nuts
beans and rice
peanut butter on bread
Folic Acid
a) how much per day?
b) which food?
c) What could prevent?
a) take 400mcg of folic acid daily
b) Dark green leafy vegetables
broccoli
lettuce
spinach
Seafood
whole grains
Calcium
a) how much per day?
b) What’s food?
c) what’s food wat with?
a) 1000mg
b) Green leafy vege
Salmon
c) vitamin D
Orange juice
Salmon
Iron
a) Why is important?
b) What’s best way to absorb more?
a) increases mom’s RBC volume
(prevent iron-deficient anemia)
b) Animal proteins+green leafy veggies+rich in vitamin C
What amount water per day?
8-10 servings/day or 1.6 L
Danger sing 1st trimester
Burring on urination
Sever vomiting(hyperemesis)
Diarrhea
Fever
Abdominal pain
Danger sing
2nd+3rd trimester
Gush fluid from the vagina(water break)
Vaginal bleeding
Abdominal pain
Change in fetal activity
Hyperemesis
Fever
Edema
Blurred vision
What can be found
a) 6 weeks
b) in 8 weeks
c) 12 weeks
a) tubular heartbeat detectable by U/S
b) All organ systems are formed
c) FHR audible with Doppler
What can be found
a) 18-20 weeks
b) 20-22 weeks
c) 23-24 weeks
a) Quickening
b) Fundus at U. Supine hypotension possible
c) Considered viable
What is the common symptoms in first trimester?
Often the first symptom of pregnancy
Occurring as early as one to two weeks
A BMI of what’s rang considered overweight?
25-30
Recommend gain is 25 to 35 lb
>30 recommends gain is 15-25lb
A nurse is providing teaching about Kegel exercises to a group of clients who are in the third trimester of pregnancy. Which of the following statements by a client indicates understanding of the teaching?
A. “These exercises help prevent constipation.”
B. “These exercises help pelvic muscles to stretch during birth.”
C. “They can help reduce back aches.”
D. “They can prevent further stretch marks.”
B
A nurse is assessing a client who is in the third trimester of pregnancy. The nurse should recognize which of the following findings as an expected physiologic change during pregnancy?
A. Gradual lordosis
B. Increased abdominal muscle tone
C. Posterior neck flexion
D. Decreased mobility of pelvic joints
C
develop a gradual, forward curving of the spine as the growth of the fetus pulls the pelvis forward.
25 weeks pregnant with twins
5 living children/Four of the 5 children were born at 39 weeks and one child was born at 27 weeks gestation
Two years ago she had a miscarriage at 10 weeks gestation
What is her GTPAL?
G=7, T=4, P=1, A=1, L=5
Twin counts G as 1 (because pregnant at the same time)
Currently 16 weeks pregnant
She has 2 year-old twins that were born at 39 weeks
A 5 year-old who was born at 40 weeks
She had no history of miscarriage or abortion
What is her GTPAL?
G=3, T=2, P=0, A=0, L=3
L counts twin as 2 because living each kids
Currently 9 weeks pregnant
She has no living children
Two years ago she had 2 miscarriages at 10 and 12 weeks
What is her GTPAL?
G=3, T=0, P=0, A=2, L=0
Weight 156lb at her 28weeks
Her pre-pregnant wight was 136lb.
Is she too much gain?
28weeks-16weeks=16
16+1.1+=136=153.1
16+4.4+136=156.4 She is OK
Biophysical Profile (BPP)?
Done if NST nonreactive. Also used to monitor at risk
pregnancies
• Categories: score 2 or 0
GBS test when?
36 weeks visit (35-37weeks)
What is the good advice to the mom who has backache?
Perform the pelvic rock exercise every day.
Use proper body mechanics.
A nurse in the prenatal clinic is performing an assessment on a client in her first trimester. Which of the following is an unexpected finding in this patient?
A - Urinary frequency
B - Persistent vomiting 断続的な
C - Fatigue
D - Breast tenderness
B
What is the
a) late term? b) post term?
a) A pregnancy that lasts 41 weeks up to 42 weeks
b) A pregnancy that lasts longer than 42 weeks
