Antepartum 2

Question 1

What is administered to the mother if there is Rh incompatibility??

Answer 1

Prophylactic RhIG can be administered to the Rh-negative (D-negative) pregnant patient to prevent formation of antibodies (alloimmunization) by destroying any fetal red blood cells in the maternal circulation before their immune system recognizes the D-positive antigen and begins to produce antibodies (Blackburn, 2018).

A dose of 300 mcg RhIG is routinely administered at 26 to 30 weeks to all Rh-negative patients without evidence of anti-D alloimmunization.

Question 2

What happens to women that have Rh incompatibility and they don’t receive treatment?

Answer 2

Without treatment, women who have increased effects ofRh incompatibilitymay produce a mildly anemic second child. Subsequent births, however, may result in fetal death due to severe antibody-induced hemolyticanemia.

Question 3

Why must pregnant patients practice enhanced safe food preparation practices?

Answer 3

Pregnant patients and their unborn or newborn children are at an increased risk for foodborne illnesses because they have a weaker immune system

Question 4

What is Naegele’s rule? How does it work?

Answer 4

-Tool used to estimate due date

1.) Determine 1st day of LMP
2.) Subtract 3 months
3.) Add 7 days

(LMP - 3 months + 7 days = EDD)

Question 5

What are nutrient needs determined by?

Answer 5

Nutrient needs are determined, at least in part, by the stage of gestation

Question 6

What does monitoring maternal lab values allow us to do?

Answer 6

Monitoring lab values allows us to determine how healthy the mom is to see how healthy the pregnancy is

Question 7

When does Rh incompatibility occur?

Answer 7

Rh incompatibility occurs when the mother’s blood type is Rh negative and her fetus’ blood type is Rh positive.

Question 8

How much weight should you gain if your BMI is 18.5-24.9? What is this BMI considered?

Answer 8

Considered normal weight

gain 25-35lbs

Question 9

In the event of Hyperemesis Gravidrum occurs, What can we do to help ensure out patients receive the required nutrients they need?

Answer 9

Intravenous fluid and electrolyte replacement, enteral tube feeding, and in some instances total parenteral nutrition have been used to nourish patients with hyperemesis gravidarum.

Question 11

What do they belive there to be an increase of that causes hyperemesis gravidarum?

Answer 11

They believe it is a by product of an increase in hCG – typically will decrease in the second trimester due to the decrease hcg

Carrying of a male baby can cause more sickness – they tend to have more hcg

Question 12

What are other indications for administering RhIG besides during delivery?

Answer 12

Other indications for administration of RhIG to Rh-negative patients during pregnancy include chorionic villus sampling, amniocentesis, spontaneous or therapeutic abortion, ectopic pregnancy, external cephalic version, and abdominal trauma

Question 13

What are positive signs of pregnancy?

Answer 13

Objective signs assessed by an examiner that can be attributed only to the presence of the fetus (e.g., hearing fetal heart tones, visualizing the fetus, palpating fetal movements). These are definitive signs that confirm pregnancy.

Question 14

At what week gestation is Rh compatibility typically done?

Answer 14

Testing to determine the pregnant patient’s blood type is done at the first prenatal visit. Rh-negative patients will also have an antibody screen in the first and third trimester

At 28 weeks, an Rh type and screen for antibodies is performed. If the patient is Rh negative and unsensitized, they should receive 300 mcg of Rh immune globulin (RhIG)

Question 15

Where does most of the weight come from?

Answer 15

Baby, amniotic fluid, and the placenta

Question 16

What does a CBC detect for antenatal lab evaluation?

Answer 16

Complete blood count/ hemoglobin, WBC: Detects anemia/detects infection

Question 17

What happens to the risk factor which Rh incompatibility and pregnancy?

Answer 17

The risk and severity of sensitization response increases with each subsequentpregnancyinvolving an Rh positivefetus.

Question 18

How many additional daily calories should a pregnant women be eating during each trimester?

Answer 18

First trimester, same as nonpregnant

second trimester, nonpregnant needs + 340 kcal

third trimester, nonpregnant needs + 452 kcal

intake of these nutrients should be adequate to support the recommended weight gain.

Question 19

What is Hyperemsis Gravidarum?

Answer 19

Hyperemesis gravidarum, or severe and persistent vomiting causing weight loss, dehydration, and electrolyte imbalances,

Question 20

What is the purpose of doing the 1 hour glucose tolerance test?

Answer 20

1-hour glucose tolerance: Screens for gestational diabetes; done at initial visit for patients with risk factors; recommended to be done at 26–28 weeks for all pregnant patients (earlier if risk factors)

Question 21

What kind of nutritional demands are required in the second and third trimester?

Answer 21

the last trimester is a period of noticeable fetal growth when most of the fetal stores of energy sources and minerals are deposited.

Thus, as fetal growth progresses during the second and third trimesters, the pregnant patient’s need for some nutrients increases greatly.

Question 22

What is considered an unweight BMI? What are these patients at a greater risk for?

Answer 22

Underweight patients (BMI <18.5) are more likely to have preterm birth, small-for-gestational-age (SGA) babies, and an increased risk of spontaneous miscarriage

Question 23

What kind of nutritional demands are required in the first trimester?

Answer 23

During the first trimester, the synthesis of fetal tissues places relatively few demands on maternal nutrition.

Therefore, during the first trimester, when the embryo or fetus is very small, the needs are only slightly increased over those before pregnancy.

Question 24

What could a sharp/rapid decrease in weight be due to?

Answer 24

Differentiation in amniotic fluid

Question 25

What does normal and underweight patients with inadequate weight gain have an increase risk for?

Answer 25

Both normal-weight and underweight patients with inadequate weight gain have an increased risk for giving birth to an infant with intrauterine growth restriction (IUGR).

Question 26

What is the most common form of Rh incompatibility? When does it become dangerous? What happens when it occurs?

Answer 26

The most common form ofRh incompatibilityoccurs when an Rh-negative mother and an Rh-positive father produce an Rh-positivefetus.

The situation does not become dangerous, however, until there is leakage from the fetal circulation into the maternal circulation.

Once a significant amount of Rh-positive blood is released into the mother’s bloodstream, a process known as red-cell alloimmunization begins.

This primary exposure of Rh-positive blood into the maternal circulation leads to sensitization, which results in the maternal production of Rh-positive antibodies called Rh immunoglobin G (IgG).

The mother’s IgG antibodies may pass through theplacentaand attack the fetal red blood cells inside thefetussince they are recognized as foreign.

Question 27

What does ABO blood type and Rh lab evaluation look at?

Answer 27

ABO blood type and Rh: Identifies fetuses at risk for developing erythroblastosis fetalis or hyperbilirubinemia in newborn period

Question 28

What can pregnant women to do help manage nasuea?

Answer 28

Rest
Frequesnt small meals
Frequent sips of water
Avoiding triggers

Question 29

What kind of smears do we do for antenatal lab evaluations? Why?

Answer 29

Vaginal or rectal smear for Neisseria gonorrhoeae, Chlamydia, HPV, GBS:

Screens high-risk population for asymptomatic infection; GBS screening recommended at 35–37 weeks for all patients

Question 30

What is sensitization with Rh incompatibility? How does it work?

Answer 30

In the majority of cases, sensitization occurs during delivery, and even then, Rh-positive firstborn infants are usually not affected.

The process of sensitization trains the body to have a response to future antigens; in this case the Rh factor present in the fetus’s red blood cells.

After sensitization, it takes time for the mother to develop Rh antibodies against the fetal blood and for her antibodies to equilibrate in the fetus’s circulation.

Because of the sensitization process, firstborn infants are usually not affected by the mother’s sensitization, unless she has been sensitized through previous amiscarriageorabortion.

If the mother has not been sensitized before the delivery, the mother does not produce enough IgG antibody response during delivery, leaving the firstborn unharmed.

Question 31

What is GBS?

Answer 31

Bacteria that can transfer from the rectum (normal flora for us to 40% of women) – not an issue for mom but more of an issue for baby during delivery that can cause resp issue or blindness – they can give 3 doses of pan-g during hospital before delivery

Question 32

What are the components of the antenatal health history assessment? What is the purpose of finding out information in each section? (5 of them)

Answer 32

1.) Menstral History
-We want to assess this so that we are able to determine pregnancy due date (EDD)

2.) Sexual History & STIs
-Want to assess Sexual history + STI so that we are able to know what kind of health practitcies mom is following and if any other assessments or testing needs to be done (Ex. Herpies – can determine what kind of delvery we have)

3.) Past Pregnacies (GTPAL)
-We want to know what the past pregnancies looked liked – full term, early or late loss – help us best support the mom to ensure mom has a healthy pregnancy

4.) Current Pregnancy history
-What are the current variables if they have already presented themselves (Ex nausea)

5.) Past medical and Surgical Hisotry
-Want to know past because a lot of those events can influence the pregnancy (Ex seizure disorders)

Question 33

How much caffeine can a pregnant woman have daily? Why?

Answer 33

-Max 300 mg daily

-May be at increased risk of miscarriage and giving birth to infants with IUGR. The ill effects of caffeine are thought to result from vasoconstriction of the blood vessels supplying the uterus or from interference with cell division in the developing fetus

(includes coffee, tea, soft drinks, and cocoa beverages)

Question 34

How much weight should you gain if your BMI is greater than or equal to 30.0? What is this BMI considered?

Answer 34

Considered obese

Gain 11-20lbs

Question 35

How much weight should you gain if your BMI is 25.0 - 29.9? What is this BMI considered?

Answer 35

Considered overweight

Gain 15-25lbs

Question 36

What is Pica?

Answer 36

Pica is an eating disorder characterized by the consumption of nonfood substances (e.g., clay, dirt, chalk, soap, and laundry starch) or excessive amounts of foodstuffs low in nutritional value (e.g., cornstarch, ice or freezer frost, baking powder, and baking soda). Pica has been associated with mineral deficiencies (e.g., iron deficiency)

Question 37

What are Probable signs of pregnancy?

Answer 37

Objective changes assessed by an examiner (e.g., Hegar sign (softening of the cervix), ballottement (a movement that you can cause by touching the outside of the uterus), pregnancy tests. These changes strongly suggest pregnancy when combined with the presumptive signs and symptoms.

Question 38

How much weight should you gain if you have a BMI of 18.5 or less?

Answer 38

28-40lbs

Question 39

What are presumptive signs of pregnancy?

Answer 39

Presumptive—Subjective changes reported by the patient (e.g., amenorrhea, fatigue, breast changes). These can be caused by conditions other than pregnancy.

Question 40

What is PICA usually a sign of?

Answer 40

Anemia

Question 41

What do we look for with vaccines?

Answer 41

Vaccines: Rubella & Varicella titre: Determines immunity to rubella, chicken pox, and parvovirus (particularly in patients with a previous child or exposure to children in the workplace)

Question 42

What are patients with obesity more likely to have while pregnant?

Answer 42

Patients with obesity are more likely to have pre-eclampsia and gestational diabetes.

Question 43

What is the best tool/practice for determining how far along a pregnancy is?

Answer 43

Ultrasound

Question 44

What is there an increased risk/ likelihood of when obesity (pre-existing or development during pregnancy) is present?

Answer 44

There is an increased likelihood of macrosomia and fetopelvic disproportion; operative vaginal birth; emergency Caesarean birth; postpartum hemorrhage; wound, genital tract, or urinary tract infection; birth trauma; and late fetal death. Patients with obesity are more likely to have pre-eclampsia and gestational diabetes.

Question 45

Causes of greater than expected weight gain during pregnancy?

Answer 45

Greater-than-expected weight gain during pregnancy may occur for many reasons, including multiple gestation, edema, gestational hypertension, and overeating

Question 46

What are the components of the GTPAL?

Answer 46

G: Total number of pregnancies the woman has had, including the current one

T: Total number of term pregnancies born after 37 weeks’ gestation (> 37 weeks)

P: Total number of preterm pregnancies (between 20 and before completion of 37 weeks’ gestation)

A: Total number of pregnancies that ended in either therapeutic abortion or spontaneous abortion before 20 weeks gestation

L: Total number of children currently alive to whom the woman has given birth

Question 47

What is the best treatment for Rh incompatibility?

Answer 47

Prevention remains the best treatment for Rh incompatibility. Since the antibody Rh IgG, or RhoGAM, was first released in 1968, it has been remarkably successful in decreasing Rh incompatibility

Question 48

Example of a bacteria/illness a pregnant women can get if she practice unsafe food preparation practices?

Answer 48

Listeriosis is a rare but serious infection caused by consuming a type of bacterium called Listeria monocytogenes (commonly called Listeria) that is sometimes found in food, water, and soil. If a pregnant patient develops listeriosis during the first 3 months of pregnancy they may experience a miscarriage.