Antepartum Flashcards
period beginning at conception and ending before start of labor
Antepartum (AP)
period of time from fertilization until delivery. 10 lunar months, 9 calendar months, 40 weeks, 280 days.
Gestation
birth after 20 weeks’ gestation, regardless of whether
the infant is born alive or dead
Parity
the capacity of fetus to live outside the uterus; approx. 24
weeks gestation
Due to lung development (Alveoli and surfactant)
Viability
the end of pregnancy before
20 weeks. May be elective or
spontaneous(miscarriage)
Abortion
the number of
complete weeks of fetal development
calculated from the first day of the last
menstrual period
Gestational Age
G: Gravida T: Term pregnancies 38-42 P: Pre-term pregnancies 20-37 6/7 A: abortions before 20 week L: living children
GTPAL: code that represents a woman’s preg history
Calculate EDC
- First day of LMP
- Subtract 3 months
- Add 7 days
Subjective, definitive diagnosis cant be made here
Presumptive Sign
Presumptive Signs
- Amenorrhea (missed period)
- Nausea
- Breast change - due to progesterone
- Frequent urination - enlarge uterus and increase pelvic blood
- Linea nigra/ chloasma
- Fatigue
More objective, be observed by medical people
Probable signs
Probable signs
- Uterine enlargement
- Chadwicks
- Goodells
- Hegars
- McDonalds
- Braxton hicks
- Ballottement
- Fetal outline
- Striae (Stretch marks)
- Lab tests
Positive signs
- Fetal heartbeat
- Fetal movements
- Ultrasound observation
purplish or bluish discoloration of cervix, vagina,
vulva by increased vascular congestion
Chadwick’s Sign
softening of cervix and vagina
Goodell’s Sign
Softening of lower uterine segment just above cervix
Hegar’s Sign
Ease in flexing body of uterus against the cervix
Mcdonald’s Sign
Rebounding of fetus by examiner’s fingers at 4-5 months
Ballottement
Able to palpate by week 24
fetal outline
90-98% accurate.
Detect presence of hCG in blood or
urine.
Lab tests
- as early as 6 weeks by US
- as early as 10 weeks by Doppler transducer
- 18-20 weeks with fetoscope
- FHR 110-160
Fetal heartbeat
Performed commonly 8-12 weeks after missed period
• Obtain thorough medical history
• Physical exam–look for health deficits
• repeat pregnancy test
• urinalysis
• pelvic exam
• lab tests
Prenatal care: first exam
check condition of organs
and birth canal
• poor predictor of who will deliver vaginally and is not routinely performed
Pelvimetry - pelvic exam
flaring wings of iliac crests of hip bones
false pelvis - pelvic exam
- Rh and ABO incompatibility
- Rh- mother and Rh + father
- mother has type O and father has type A, B, or AB
- Rubella titer
- Hgb and Hct–12mg/dl and 35% desirable
- Serology for STD’s and AIDS
Lab tests preformed
Maternal infections may cause congenital
malformations or disorders in infant especially if
exposed during the first 12 weeks of gestation
TORCH infections *
TORCH Infection list
• T—toxoplasmosis - Cat Liter can cause birth defects
•O—other (gonorrhea, syphillis, varicella, hepatitis
B(HBV), HIV
•R—rubella
• C—cytomegalovirus (CMV)
•H—herpes simplex virus (HSV)
• 1 x/month for 7 months, then q 2 weeks during the 8th month, then
weekly during last month
• Assessments
• Weight–25-30 pounds average gain
• 2-4# in 1st trimester, 1/2 # per week in 2nd trimester, 1# per week in last 4-6
weeks
Subsequent Prenatal visits
•Vital signs--especially BP. Early detection of PIH vital. •Vaginal exams per discretion •UA for infection, sugar, albumin •Fundal height measurement--begin at 16-20 weeks. Centimeters measure correspond with gestational age
Prenatal visit assessments
- Fetal heart tones (FHT)/fetal heartrate (FHR) by doppler
- Assess for common problems
- N/V
- edema
- bleeding
- constipation
- headache (HBP or stress)
Prenatal visit look fors
- Ultrasound
- Glucose Challenge Test (28 weeks)
- H&H (S/S of anemia)
- RhoGAM work-up (If O- blood get this to protect baby if it is +)
- Group Beta Strep (34-37 weeks for strep)
Prenatal testings
• Normal vaginal flora
• Woman asymptomatic but can cause serious infection of newborn
• Vaginal and rectal cultures to detect presence in pregnant woman
• If present will treat with IV antibiotics during labor–usually 2+ doses
of Ancef or ampicillin
Group Beta Streptococcus
Often done by the nurse!
S/S to report
• bleeding, fluid leaking from vagina (means cervix is dilated and water broke)
• rapid weight gain (pre-eclampsia)
• swelling of extremities and/or face (edema, leads to pre-eclampsia)
• persistent headache, visual disturbances (BP rising)
• fever>100.4 (infection)
• vomiting (infection)
Prenatal visit teaching
•Increase of 300 kcal/day •Balanced diet with increased intake of foods that will provide needed vitamins, minerals, proteins. •Diet should supply needed nutrients, but routine supplementation of “prenatal vitamins” given •Increase fluids, especially water
Prenatal visit: Diet
essential for preventing neural tube defects
Folic acid
get from dark, leafy greens
• Employment–avoid toxic fumes, falls, heavy lifting, prolonged sitting
or standing
• Bathing/Hygiene–increased sweating and oil gland secretion, vaginal
secretions.
• Sexual intercourse–CI in pre-term labor
Prenatal Visit teaching
Drugs, alcohol and smoking cause…
LBW, prematurity, birth defects and increase in fetal death
