Antepartum Flashcards
Cardiovascular System
Cardiac output increases 30-50% HR increases 15-20 BPM BP remains stable Compression of iliac veins and inferior vena cava Vena caval syndrome Dependent edema Varicose veins; hemorrhoids Increased risk for VTE
Cardiovascular System
↑ Total blood volume
↑Plasma volume > ↑Red blood cell volume =↓ Hgb & Hct
Physiologic anemia of pregnancy
Protective mechanism
Perfuse uterus
Hydrate fetal and maternal tissues
Fluid reserve for blood loss at birth and post-partum
↑White blood cell count
↑ granulocytes
↑Blood coagulation
↑Clotting factors + ↓coagulation inhibiting factors= hypercoagulability
Protective mechanism ↓ Fibrinolytic activity ↓ Risk of bleeding ↑ Risk of thrombus Post-cesarean
Respiratory System
Upper respiratory tract Nasal/sinus stuffiness; epistaxis; changes in voice Impaired hearing; earache; ear fullness Structural adaptions Diaphragm rises by up to 4 cm Chest circumference increases by 5-7 cm Pulmonary function Tidal volume increases by 40% Mild, chronic hyperventilation Reduced arterial carbon dioxide
Gastrointestinal System
Appetite and Mouth Fluctuations in appetite Food aversions and cravings Pica—may signify a dietary deficiency Gums edematous and bleed easily Esophagus, Stomach and Intestines Delayed gastric emptying, decreased peristalsis Heartburn; bloating; cramping; flatulence; constipation Hemorrhoids late in pregnancy Gallbladder distends Risk for gallstones
Renal System
Anatomic changes
Ureters dilate, elongate and become torturous
Urinary stasis; alkalotic=increased risk for UTIs
Enlarging uterus presses against the bladder
Bladder irritability; nocturia and urinary frequency
Functional changes
Increased GFR by 50%
Increased creatinine clearance
Reduced serum creatinine, BUN and uric acid levels
Renal System
Fluid and electrolyte balance
Increase in total body water of 6.5-8.5 L
Sodium is retained to maintain balance
Glycosuria
Because of the kidneys’ inability to reabsorb all the glucose filtered by the glomeruli
May indicate gestational diabetes
Increased excretion of protein and albumin
Proteinuria + hypertension=increased risk for adverse outcomes
Musculoskeletal System
Changes in posture and center of gravity (bottom picture)
Lordosis; back pain
Loosening of ligaments and separation of recti muscles (top pictures)
Waddling gait
Integumentary System
Skin ↑Melanotropin=Hyperpigmentation Melasma Linea nigra ↑Estrogen=↑blood flow to skin Angiomatas (vascular spiders) Palmar erythema Mechanical stretching Striae gravidarum (stretch marks) Hair and nails Accelerated growth Hirsutism
Breasts
Fullness, heightened sensitivity, tingling and heaviness
Blood vessels dilate and become visible
Areoles more pigmented and nipples more erect
Sebaceous glands secrete substances to lubricate and prevent infection
Mild tingling to sharp pain
Mammary glands grow in 2nd and 3rd trimester
Colostrum production begins at the end of the 1st trimester
Uterus
Changes in size, shape, and position Increases to 1200 grams at term Changes into an oval shape Assessed by measuring fundal height Can estimate weeks of gestation Changes in contractility Braxton-Hicks contractions Uteroplacental blood flow Depends on maternal blood flow to uterus Blood flow can be decreased by Low maternal BP Uterine contractions Supine positioning
Cervix, Vagina and Vulva
Cervix Goodell sign Friability Vagina Chadwick sign Leukorrhea Change in vaginal microbiome Vulva External structures are enlarged
Prenatal Care Management
Goal: promote health and well-being of the pregnant person, the fetus, the newborn and the family
Locations and team members
OB doctors, Family medicine MDs, CNMs, NPs, PAs, PH nurses, RD, Childbirth educators, doulas, lactation consultants, psychiatric, social work, case management
Clinic, public health locations, homes, birthing centers
Prenatal Care Management and Public Health
Primary prevention Education about nutrition, physical activity, self-management of pregnancy discomforts, psychosocial impact of pregnancy Secondary prevention Screening for risk factors for early intervention Barriers to prenatal care and outcomes Preterm birth Low birth weight Infant mortality
Initial Prenatal Visit
Goal: To establish a trusting relationship with the patient and their family
Comprehensive health history of pregnant person, their partner, their families and any children
Menstrual history
Current pregnancy and OB history
Gravida and parity
Method of prior deliveries and anesthesia
Complications with prior deliveries
Medical and Surgical History
Preexisting conditions
Pap test results, history of STIs, contraceptive use
History of gynecological or abdominal surgeries
Initial Prenatal Visit
Nutrition Food allergies, eating disorders, pica or hyperemesis gravidarum Family history Genetic disorders, recent illness Current medications OTC, herbs, vitamins, supplements Substance abuse Tobacco, alcohol, illegal drugs Psychosocial history Emotional response to pregnancy, lifestyle, exercise Mental health—depression risk Abuse history or risk Intimate partner violence
