Antepartum Care Flashcards
Antenatal period & pregnancy duration
- conception to labour
- 40 weeks (1st day of LMP to labour)
- 3 trimesters:
1. Week 1-12
2. Week 13-27
3. After week 28
Presumptive signs of pregnancy (subjective)
- Breast tenderness (3-4 weeks)
- Amenorrhea (4 weeks)
- Nausea and vomiting (4-14 weeks)
- Breast enlargement (6 weeks)
- Urinary frequency (6-12 weeks)
- Uterine enlargement (7-12 weeks)
- Fatigue (12 weeks)
- Hyperpigmentation of skin (16 weeks)
- Fetal movements (quickening) (16-20 weeks)
Probable signs of pregnancy (objective)
- Positive pregnancy test (4-12 weeks)
- Goodell’s sign - softening of cervix (5 weeks)
- Chadwick’s sign - blueish purple colouration of the vaginal mucosa and cervix (6-8 weeks)
- Hegar’s sign - softening of lower uterine segment or isthmus (6-12 weeks)
- Abdominal enlargement (14 weeks)
- Ballottement (16-28 weeks)
- Braxton hicks contractions (16-28 weeks)
Positive signs of pregnancy
- Ultrasound verification of embryo or fetus (4-6 weeks)
- Auscultation of fetal heart tones via Doppler (10-12 weeks)
- Fetal movement felt by experienced clinician (20 weeks)
Danger signs of pregnancy
- Vaginal bleeding
- Persistent vomiting
- Chills & fever
- Abdominal/chest pain
- Hypertension/excessive weight gain
- Edema, eye changes
- Rupture membranes
- Increase or decrease of Fetal movement
Ultrasonography stages
Dating scan: in first 12 weeks of pregnancy, confirm and see gestational sac
Fetal anomaly scan: 20-22 weeks of pregnancy, physical anomaly
Growth scan: 30-32 weeks of pregnancy, growth (maturity, sex)
Chromosomal anomalies
- triple test
- amniocentesis
- chronic villus sampling (CVS)
Risk factors of PIH
- Multiple pregnancies
- Primigravida (<20 years or >40 years)
- Chronic renal disease
- Poor nutrition - obesity
- Hydramnios
- Diabetes mellitus
- Chronic hypertension
- Family history
- Black race
Gestational hypertension
BP >140/90
Mild pre eclampsia
BP >140/90
Mild proteinuria or Edema
Systolic/diastolic >30/15 mmhg
Severe preeclampsia
BP 160/110
Diastolic 30mmhg more
Edema of different levels
Proteinuria (3+/4+) / >5g/24 hours urine
Headache, blurred vision, nausea, vomiting
Eclampsia
Seizure or coma occurs due to cerebral Edema
Fetal hypoxia; fetal morality rate of 25%
Antepartum/intrapartum/postpartum eclampsia
Risk factors of GDM
- Personal/family history of GDM
- Previous unexplained stillbirth
- Marked obesity
- Glycosuria
Nursing management to promote self care
- Personal hygiene
- Perineal care
- Dental hygiene
- Breast care
- Nutrition
- Exercise
- Sleep and rest
- Sexual activity & sexuality
- Medications
- Clothing
Threatened spontaneous abortion
- Vaginal bleeding
- Spotting
- Cramping
- No cervical dilation
Inevitable spontaneous abortion
- Cramping
- Bleeding with cervical dilation
- Amniotic fluid may leak
Incomplete spontaneous abortion
- Some of the POC are expelled
- Membrane and placenta retained with cervical dilation
Complete spontaneous abortion
- All POC are expelled
Missed spontaneous abortion
- Fetus dies but remains in the uterus.
- Uterine growth ceases
- Breast changes regress
- History of symptoms of threatened miscarriage
- Brownish vaginal discharge
- Cervix os is closed
Risk factors for spontaneous abortion
- Advanced maternal age
- Previous pregnancy loss
- Maternal chronic disease
- Infections
- Structural uterine abnormalities
- Significant trauma
- Underlying endocrinological or gynaecological disorders
- Exposure to substances like tobacco, alcohol, drugs or environmental contaminants
- History of spontaneous abortion
Complications of spontaneous abortion
- Infection leading to septic abortion (spontaneous or induced abortion complicated by severe uterine infection)
- Disseminated intravascular coagulation (DIC)
- Trauma to the uterus from surgical intervention
Other clinical manifestations of complete/incomplete abortions
- Abdominal pain
- Cramping or contractions
- Vaginal bleeding
- Open cervix on pelvic examination
- If abortions occurs secondary to infection,
- fever
- purulent vaginal discharge
- hypotension
Can also occur as infection progresses to septic shock
Diagnosis for spontaneous abortion
- client’s history & physical assessment
- ultrasound
- laboratory testing (CBC, hCG & progesterone levels)
- cultures from various sites (blood cultures)
Nursing assessment for spontaneous abortion
- Vaginal bleeding
- Cramping or contractions
- Vital signs, pain level
- Patient’s understanding
Clinical manifestations for PIH
- Hypertension
- proteinuria
- Edema
- Headache, blurred vision, nausea & vomiting, convulsion, coma
Diagnosis of PIH
- Client’s history & physical assessment
- Lab test
Nursing assessment of PIH
Risk factors
BP
Nutritional intake
Weight
Edema
Urine for protein
Other laboratory tests if indicated
Risk factors of hyperemesis gravidarum
- Multi gestational pregnancy
- Primigravida
- Gestational trophoblastic disease
- White race
- Family history of hyperemesis gravidarum
- Those with history of motion sickness or migraines
Signs and symptoms of hyperemesis gravidarum
- Nausea and vomiting several times a day or persist throughout the day
- Dehydration - weight loss; decreased urinary output, dry skin or mucous membranes, decreased skin tugor
- Hypotension
- Tachycardia
- Dizziness
