Antepartum (AP) Flashcards
Antepartum (AP)
Period beginning at conception & ending before start of labor
Gestation
Period of fertilization until delivery
EDC/EDB
Estimated date of confinement/birth = due date
Gravida
Any pregnancy regardless of duration
Nulligravida
Woman who has never been pregnant
Primigravida
Woman pregnant for the first time
Multigravida
Woman who has been pregnant more than once
Parity
Births after 20 weeks gestation, regardless of whether infant is born alive or dead
Nullipara
Woman who has not completed a pregnancy by the beginning of 20 weeks
Primipara
Woman who has completed one pregnancy by the beginning of 20 weeks
Multipara
Has completed 2 or more pregnancies by the beginning of 20 weeks
Gestational Age
Number of complete weeks of fetal development calculated from the first day of the last menstrual period (LMP)
Term
Fetus born between 37-41.6 weeks gestation
Pre-term
Fetus born between 20-36.6 weeks gestation
Abortion
End of pregnancy from conception to 19.6 weeks
- Elective or spontaneous (miscarriage)
GTPAL
Code that represents a woman’s history
- G: Gravida (# of pregnancies)
- T: Term pregnancies
- A: Abortions
- L: Current living children
Nagele’s Rule: Calculating EDC (Estimated date of confinement)
- Identify 1st day of LMP
- Count backward 3 months
- Add 7 days
- Ex: LMP is November 7
- Answer: August 14th
Amennorrhea
- Absence of menstrual periods
- May be caused by strenuous experience, metabolism changes, endocrine dysfunction, medications, and psych disorders
Presumptive Signs of Pregnancy
- Nausea/vomiting; subsides after 1st trimester
- Breast Changes
- Urinary Disturbances: Frequent urge; relieved in 2nd trimester, reoccurs in 3rd
- Fatigue: Due to increased metabolic needs
- Quickening: 18-20wks
- Pigment Changes: Darkening of nipples/areolas, linea nigra, chloasma
Linea Nigra
Dark line that forms during pregnancy from your belly button to the suprapubic area
Chloasma
- “Mask of pregnancy”
- Darker area that forms on face in mostly Native American and Black patients
Probable Signs of Pregnancy
- At home pregnancy test
- Uterine enlargement: By end of week 12 fundus can be felt above the symphysis pubis
- Chadwick’s Sign
- Goodell’s Sign
- Hegar’s Sign
- Braxton Hicks Contractions
- Fetal Outline: Able to feel by week 24
- Ballottement: Rebounding of fetus by examiner’s finger at 4-5 months
Chadwick’s Sign
Purplish or bluish discoloration of the cervix, vagina, vulva by increased vascular congestion
Goodell’s Sign
Softening of the cervix
Hegar’s Sign
Softening of the lower uterine segment just above the cervix
Positive Signs of Pregnancy
- Fetal Heartbeat (US: 6wks, Doppler: 10wks, Fetoscope: 18-20wks)
- Fetal Movements
- Ultrasound (Gestational sac seen at 4-5wks, embryo visible 6-8wks)
- Performed 8-12 weeks after missed period
- Obtain thorough medical, family, OB history
- Physical exam - look for health deficits
- Pelvic Exam
Pelvimetry
Check condition of organs and birth canal
False Pelvis
Flaring wings of the iliac crests of hip bones
1st Visit Lab Tests
- Repeat pregnancy test
- Urinalysis
- Blood type/Rh Factor (Rh & ABO incompatibility)
- Titers (Rubella, Varicella)
- CBC (Hgb & Hct - 12mg/dl & 35% desirable)
- Serology for Hep B, Syphilis, & HIV
- Papsmear & HPV DNA test
- Gonorrhea/Chlamydia culture
Nursing Responsibilities 1st visit
- Assist with taking history and pelvic exam
- Explain procedures
- Teaching: Normal pregnancy, discomforts vs danger signs, S/S to report
- Provide support
Prenatal Visit Assessments
- Vital signs
- FHR
- Fundal height measurement
- Urinalysis
- Vaginal exams
What common problems should the nurse assess for during prenatal visits?
- N/V
- Edema
- Bleeding/spotting
- Constipation
- Headache
- UTI
- Yeast or Bacterial Vaginosis
Prenatal Diet
- Increase of 300 cal/day
- Balanced diet will provide needed vitamins, minerals, proteins
- Routine supplements “Prenatal vitamins” prescribed
- Increase fluids, water
Prenatal Clothing
- Need larger clothes by 3rd months
- Wide strap support bra
- Avoid restrictive clothing especially in pelvis & legs
- Wear comfortable, low heel shoes
Prenatal Activity & Rest
- Pre-pregnancy activities usually okay
- Moderate walking, swimming, modified yoga/pilates
- Plan for rest periods
- Sit or lie with feet up for 20-30 min
Common Discomforts of 1st Trimester
- Painful breasts
- Urinary urgency/frequency
- Fatigue
- N/V - low fat, high carb
- Mood swings
- Increased vaginal discharge (Yeast/BV?)
- Nasal stuffiness
Common Discomforts of 2nd Trimester
- Heartburn
- Constipation: Increase fluids, fiber
- Leg Cramps: change position frequently, dorsiflex, increase calcium, don’t massage
- Varicose Veins: Compression socks, rest frequently with feet elevated, light to moderate walking
- Backache: Good posture, sleep on side, lordosis (excessive inward curve of spine)
Common Discomforts of 3rd Trimester
- Varicosities worsen: Hemorrhoids, vulvar varicosities
- Dyspnea
- Hypermobility of joints: Relaxin loosens connective tissue
- Edema: Report edema of face/hands
- Backache
- Insomnia
