Antepartum 2 Flashcards
Preconception care
health of women and partner- BEFORE PREGNANCY
What info is reviewed?
Personal and family history, physical examination, laboratory screening, reproductive planning, nutrition, supplements, weight, exercise, vaccinations, and injury prevention
GREATESTS risk time-frame
- Between 17 & 56 DAYS AFTER conception
- Up to wk. 14 of gestation
prenatal visits:
from conception up to week 28
evry 4 weeks
Prenatal visits:
Week 28 up to week 36
every 2 weeks
prenatal visits:
week 36 up to week 40
weekly visits
First prenatal visit consists of
- Counselling & education (Nutrition, do’s & don’ts)
- Laboratory Tests
- Threshold for Dx of GDM in pregnancy
Lab tests taken in FIRST prenatal visit
- Urine or Blood test
- hCG
- Diabetes Mellitus – Tight control
- Gestational Diabetes (GDM)- on the rise
estimated due date (EDD) usinmg NAGELES RULE
- FIRST DAY of LAST menstrual period
- Subtract 3 months
- Add 7 days
- Adjust year if needed
Terms to know:
GTPAL is used todocument a woman’s obstetric history
G= gravida
T= term births
P= Preterm pregnancies
A= abortions
L= living children
Total number of pregnancies
Gravida
Term gestations delivering between 38-42 wks OR after 37 wks.
Term
Number of preterm pregnancies delivering between 20 & 37 wks.
Preterm
Number of pregnancies ending before 20 wks. or elective abortions
Abortion
Number of living children
Living
HEAD-TO-TOE assessment:
Head and neck
- prev. injuries
- sequelae
- limitations of ROM
- enlarged lymph nodes or sweeling?
- edema of nasal mucosa
- hypertorphy of gingival tissue (increased estrogen levels)
- thyroid gland enlargment
HEAD-TO-TOE assessment:
Chest
- soft systolic murmur=. normal (incr in blood volume)
- incr heart rate
- incr chest diameter
- incr RR
- fuller breasts
- striae gravidarum (stretch marks)
- darker nipple and areola
- enlargement of montgomery glands
HEAD-TO-TOE assessment:
extremities
- edema
- pulses
- varicose veins
- 3rd trimester edeam =only normal
- pain in calf
HEAD-TO-TOE assessment:
Abdomen
- rounded and nontender
- decreased muscle tone
- 12 weeks: fundus @ symphysis pubis
- 16 weeks: fundus b/t symphysis and umbilicys
- 20 weeks: @ umbilicus
- 36 weeks: just below xiphoid process
Pelvic exam:
3 measurements are assessed:
- Diagonal conjugate (DC)
- true conjugate (aka obstetric conjugate)
- ischial tuberosity (transverse diameter of pelvic outlet)
Pelvic exam consists of
- External genitalia: lesions, discharge, inflammation, STI (visual)
- Internal Genitalia: goodell sign, hegar sign, chadwick sign (blue cervix)
- Pap smear
- bimanual examination
PELVIC EXAM DONE BY HCP ONLY!!
type of pelvic measurement:
* Distance b/t anterior surface of sacral prominence & anterior surface of inferior margin of symphysis pubis.
Diagonal conjugate
Diagonal Conjugate- things to know
- DC usually 11.5 cm or >
- represents anteroposterior diameter (AP) of pelvic inlet which fetal passes FIRST.
type of pelvic measurement:
- measurement from Ant. surface of Sacral prominence to the Post . surface of inferior margin of symphysis pubis.
- Can not be measured DIRECTLY.
True conjugate
(aka obstetric conjugate)
Type of pelvic measurement:
- Measurement made OUTSIDE the pelvis at the LOWEST aspect of the ischial tuberosities
ISCHIAL TUBEROSITY
Things to know about True conjugate
- roughly 11.5 cm
- SMALLEST Anteroposterior diameter
Ischial Tuberosity is best when
- diamter of 10.5 cm or > = adequate passage of the fetal.
Additional lab studies include
- Rh status-mom
- Rubella titer
- HIV testing
- STI screening
- Cervical smears
- UA
- Glucose
- CBC
What to know about RH
- Mom NEEDS to be Rh-sensitive
- If not Rh sensitive you administer RhoGAM
Rh-NEG mother will receive testing (mom not sensitive)
- at 28 weeks and again within 72 hrs AFTER childbirth (if she is RH-sensitive)
- Rubella Titer detects antibodies for virus that causes German measles.
- Things for mom to keep in mind:
- titer is 1:8 or < = mom is nOT IMMUNE.
- requires immunization AFTER birth.
- Mom is advised to AVOID people with undiagnosed rashes.
If mom is HIV +
- Requires more testing, counseling, and tx.
- Rx to prevent transmission to fetus
STI screening include following tests
- veneral diseases researh laboratory (VDRL)
- rapid plasma reagin (RPR)
- cultures
- lesions
- cervical smears test for
for syphilis, herpes, HPV, gonorrhea
UA tests for
- albumin
- glucose
- ketones
- bacteria
Glucose is tested on patients
that are high-risk
What is this called?
Leopold’s manuevers
Describe each pic
- locate FUNDUS
- find ant and post of baby by pressing SIDES
- Cervical area- find presenting part (head- harder or butt-squishy)
- Checking position of baby (vertex or breach)- Symphysis pubic
fetal heart rate should be
- Fetal HR (110 to 160 bpm)
Fundal Height measurement
- Reflects fetal growth
- Gross estimate of duration of pregnancy
- Fundal height = # of wks. until 36 wks.
Fundal height measured in what position?
“Mcdonalds Method”
-supine position
-knees slighly flexed
Fetal movement:
Quickening occurs during (baby movements)
2nd TRIMESTER.
Fetal movement:
When to start counting fetal movement
28 weeks OF PREGNANCY
HOW to count fetal movement
- sit or lie on side
- record time of 1st mvmnt
- count until 10 mvmnts
- record time of 10th mvmnt
- NORM: 10 mcmnts in 2 hrs or SOONER
When to call HCP regarding FETAL MVMNTS
more than 2 hrs and only felt 10 movements
Call HCP if women experiences MENTRUAL-LIKE CRAMPS that are
- occurring every 10 mins
- low, dull backpain
IF menstrual like cramps occur, what should the mother do?
- Stop activity & lie down on left side for 1 hr.
- Drink two or three glasses of water
- If symptoms worsen or DO NOT subside after 1 hr. - Contact health care provider
Dx test that
* Measure velocity of blood flow through umbilical cord
* Detect fetal compromise
* ID abnormalities in diastolic cord flow
DOPPLER FLOW STUDIES.
when performing ULTRASOUND during EARLY pregnancy, what is needed?
A FULL BLADDER
ALPHA FETOPROTEIN ANALYSIS: if found in mothers serum (blood), is this considered normal?
NO! it is a GLYCOPROTEIN which in high levels are related to failure of neural tube to close.
Alpha Fetoprotein Analysis is TESTED on what weeks?
16-18 weeks
Transabdominal puncture of amniotic sac drawn for analysis.
Amniocentesis
Amniocentesis test for
- Chromosomal abnormalities
- Evaluate fetal condition
- Diagnose intrauterine infection
- Investigate AFP if MS levels HIGH
when is Amniocentesis RECOMMENDED
15-20 weeks
Results in 3 weeks!!!
Amniocentesis:
Normal color
clear, white flecks of vernix caseosa in mature fetus
Amniocentesis:
Bilirubin levels norm is
absent at term
Amniocentesis:
Meconium
absent
Amniocentesis:
creatinine should be
> 2 mg/dL in mature fetus
Amniocentesis:
Lecithin/ Sphyngomyelin should be
> 2 fetal pulmonary maturity
Amniocentesis:
Bacteria
absent
Amniocentesis:
chromosomes
normal karyotype
At ANY PRE-PROCEDURE YOU ALWAYS NEED ___ SIGNED
Informed consent
Administer RhoGAM IM if woman is
Rh -ve
(Rh-pos = dnt do anything)
AFTER A AMNIOCENTESIS procedure what symptoms should be notified to HCP
- Fever
- Leaking amniotic fluid
- Vaginal bleeding
- Uterine contractions
- Changes in fetal activity - increased or decreased
Chorionic Villus Sampling to know
- 10-13 weeks.
- Few risk than amniocentesis
- Results within 48 hrs.
- Lithotomy position
What to explain to pt with CHORIONIC VILLUS SAMPLING
- Informed consent – witness sign NEEDED
- Urge not to engage in any strenuous activity for next 48 hrs.
- Administer RhoGAM if Rh-negative
Notify HCP:
* Fever
* Cramping
* Vaginal bleeding
ANY test that goes thru amniotic sac a _____ test is done
RhoGAM
Test done to/for:
- Measure PERFUSION
- Recommended 2 X week (after 28 wks.)
- WHO has:
-Diabetes
-Other high-risk conditions - Mom presses button every time theres movement
- NON-STRESS TEST
EMPTY BLADDER
MEASURES BABYS HEART RATE
The NORMAL for Non-Stress TEst (NST)
2/15/15
- 2 fetal heart beat acceleration from baseline
- > 15 beats per min
- last 15 seconds
in 20 min recording
anything outside this NEEDS ADDITIONAL TESTING
Best time to travel
18-24 weeks.
(roughly 5 months)
IMPORTANT:
IMMUNIZATION while pregnant
- Avoid LIVE virus (MMR & varicella)
or - Avoid pregnancy within 1 M of live vaccines
Medications to AVOID while pregnant
- Midazolam
- corticosteroids
- ticagrelor
- ace-inhibitors (-pril)
- ARBS
- Statins
- NSAIDS (after 24 weeks)
- Aspirin (after 24 weeks)
- ASA/Caffeine
- Tetracyclines
- Warfarin
- Lithium
- CT/IV contrast
What is this method called?
*Goodells and hegars method
* test for pregnancy (not 100% method to prove pregnancy)
Lab results that states you are positive for GESTATIONAL DIABETES MELITIS
- Fasting plasma glucise: 126 mg/dL
- HbA1c: 6.5% or higher
- Random plasma glucose: 200 mg/dL
