antepartum (unit 1) Flashcards
presumptive signs of pregnancy
- subjective
- breast/abdominal enlargement
- skin changes
- amenorrhea
- N/V
- fatigue
- urinary freq.
- quickening
- breast tenderness
probable signs of pregnancy
•objective (examiner) •uterine enlargement •cervical changes •braxton hicks •ballottement- push down and bounce back *positive preggo-test
false negative preggo test
- too soon
- urine dilute
- ectopic PG
- improper technique
fasle positive preggo test
- UTI (protein/blood in urine)
- recent pregnancy
- drugs
- tumor
positive signs of pregnancy
- confirms presence of fetus
- fetal HT 10-12 weeks
- visual in abd. 5-6 wks
- visual in vag. 16 days
LMP
•last menstrual period
CD
•conception date
EDD
•estimated date of delivery
EDC
•estimated date of confinement
EDB
•estimated date of birth
length of pregnancy
•280 days (40 wks) •3 trimesters 1. 1-13.9 wks 2. 14-26.9 wks 3. 27-40 wks
Nagele’s Rule for EDD
- subtract 3 from the month # of LMP
* add 7 to the day # of LMP
gravida
•# of pregnancies
para
•# of pregnancies reaching 20 wks GA
term
•deliveries at 38-42 wks
preterm
•deliveries prior to 37 wks and after 20 wks
post-term/postdates
• > 42 wks GA
abortion (Ab)
•ETOP- elective termination of pregnancy
•SAB- spontaneous abortion
•TAB- therapeutic abortion (medical reasons)
*abortion at less than 20 wks
GTPAL system
- gravida
- term
- preterm
- abortion
- living
pregnancy after twins
- G2
- T1
- P0
- A0
- L2
safe category drugs
- A
* B
questionable category drugs
- C
- weigh risks w/ benefits
- Ex: Zoloft
contraindicated category drugs
- D (seizure drugs)
- X (NEVER give)
- proven fetal harm
pancreas changes during pregnancy
- 1st trimester: dec. insulin (fetus takes glucose)
* ⅔ trimester: mom inc. resistance to insulin (more supply glucose for fetus)
progesterone
•"hormone of pregnancy" •secreted from ovary/placenta •effects -maintains uterine lining -relaxes uterine smooth muscle -prepares breasts for lactation -maternal fat stores (w/ estrogen)
estrogen
•secreted from ovary/pl •effects -uterine, genital, breast growth -ducts for lactation -skin changes
human chorionic gonadotropin (hCG)
•first produced by fetus •effects -positive preg. test •prevents involution corpus luteum •hormone that makes people "feel" pregnant
hCG and progesterone
•work together to maintain pregnancy
•hCG maintains corpus luteum
•corpus luteum produces progesterone until placenta
*drop of either results in miscarriage
relaxin
•from ovary and placenta
•effects
-softens muscles/joints of pelvis
-inhibits uterine activity
oxytocin
•from post. pit
•effects
-uterine ctx
-milk ejection (let down) reflex
prolactin
- from ant pit
* hormone of milk production
aldosterone
- from adrenals
* increases during pregnancy to conserve Na+ and maintain fld balance
thyroxin (T4)
•inc. when estrogen inc.
•causes bigger thyroid
•inc. BMR for 1st trimester
*hyperactive thyroid during pregnancy (hard to regulate in 1st trimester if had previous issue and are on meds)
human chorionic somatommotropin (hCS)
- from placenta
* growth hormone affecting breast development and decreasing maternal metabolism
uterus growth during pregnancy
•12 wks: rise out of pelvis
•16 wks: midway b/t symphysis and umbilicus
•20 wks: umbilicus
•38-40 wks: FSH dec -> lightening (feel better)
*grows 1 cm/wk
funic souffle
- blood rushing through umbilical vessels
* sync w/ fetal heart beat
uterine souffle
- blood in uterine arteries
* sync w/ maternal pulse
Hegar’s sign
- softening of lower uterine segment
* 6-8 wks
Goodell’s sign
- cervical softening r/t congestion of blood
* 6 wks
Chadwick’s sign
- bluish color of cervix r/t inc. vascularity
* 8-12 wks
mucus plug (operculum)
- barrier in cervix
- protects baby from bacteria
- sloughing of vaginal cells caused by progesterone
leukorrhea
- changes in vaginal acidity to protect against infection
* due to increased lactic acid production making mom more vulnerable to yeast infection
cardiovascular changes during pregnancy
•inc. clotting factors •dec. fibrinolytic (prevent clots from sticking) activity •inc. WBC and RBC •inc. blood vol. -> inc. CO •inc. pulse •inc. respirations •dec. BP during 2nd trimester *extremely high risk for blood clots
pseudo (physiological) anemia
•inc. in RBC, but diluted by expanded blood vol., so looks like anemia
•Hct < 35%
•Hgb < 10%
*lower than normal H&H okay as long as they are tolerating it
why does BP decrease 5-10mmHg during 2nd trimester
•b/c have extra volume and body responds by signaling vasodilation to relax vessels and lower BP
dependent (physiologic) edema
- poor venous return d/t pressure of uterus
- creates pooling/varicose veins in LE
- pt should avoid tight clothing/shoes
urinary changes during pregnancy
- bladder capacity doubles
- filtration rate inc.
- inc. risk for infection
- ketones/protein in urine bad
protienuria during pregnancy
•not good b/c can lead to irreversible kidney damage (too big to filter)
•if in combo w/ HTN risk for preeclampsia
*check at every appt.
integumentary changes during pregnancy
- chloasma (face pigment)
- linea nigra
- vascular spiders
- palmar erythema (r/t estrogen)
- striae gravidarum (collagen stretch)
- epulis (gum hypertrophy)
- acne
causes of leg cramps during pregnancy
- impaired circulation
- low K+
- high P
- low Ca++
- low Mg++
round ligament pain
- sharp pain in abd. extending to pelvis/vag
- caused by stretching of ligaments as uterus grows
- tx w/ Tylenol, NOT NSAIDs
causes of fatigue during pregnancy
- hypoglycemia
- initial fall in BMR (1st tri)
- progesterone
neurologic system changes during pregnancy
•sciatic nerve pain •sensory changes in legs •tension HA •carpal tunnel (r/t edema compression) •acrothesias (numb hands) •hypocalcemia (cramps) *nerve/sensory s/sx
ptyalism
•excessive secretion of saliva
morning sickness causes
- inc. hCG, estrogen, progesterone
- hypoglycemia
- altered carb metabolism
- tx w/ gum, hard candy, oral care, etc
hyperemesis
•severe morning sickness
•requires frequent monitoring of weight/electrolytes
•may need hospitalization and IV tx
*r/o appendicitis
pyrosis
- heartburn
- caused by progesterone decreasing peristalsis and vasodilating smooth muscle
- tx w/ anti-acids and diet modification
pica
- carving/eating abnormal things
- ice is common in preggo
- may indicate signs of anemia
constipation during pregnancy
•most common in 3rd trimester •d/t -dec. peristalsis -iron supplements -dehydration -dec. activity level •tx w/ H2O, fiber diet, colace
reason for hemorrhoids during pregnancy
- increased vascularity
- increased pressure
- constipation
nutrition increase requirements during pregnancy
- iron- O2 demands
- vitamin C- absorb iron
- calcium- teeth/bone formation
- inc. caloric intake by ~300
nutrition during lactation
- inc. by 300 kcals/day for first 6 months
* inc. by 400 kcals/day after 6 months
adequate antepartum care
- 13 visits
* begin before 20 post-conception (later is high risk)
initial prenatal visit
- health hx
- OB hx (GTPAL)
- GYN hx (menstrual cycle; contraception; fertility; STDs)
- family hx (mom primarily)
- psychosocial profile
- physical assessment
initial prenatal visit exam
•verify pregnancy and establish EDD
*U/S most accurate method
•establish baseline numbers (VS, weight, etc)
initial prenatal visit labs
- CBC- platelets; anemia
- type Rh (redraw in L&D)
- rubella titer
- HBSaG
- RPR or VDRL
- HIV
- gonorrhea/chlamydia cultrer
- urinalysis/culture
ABO incompatibility
- A and B blood doesn’t mix w/ O
- if mom is O and baby is A or B, then mom can produce antibodies that attack baby
- can cause fetal jaundice or anemia
- no tx
Rh incompatibility
- Rh (D) negative women who give birth to Rh (D) positive infants may develop anti-D antibodies
- These antibodies are made when the Rh negative blood is exposed to Rh + blood (exposed to the “D” antigen)
- These antibodies then can attack the next fetus resulting in serious illness and death due to erythroblastosis fetalis
Rhogam
- drug that reduces # of anti-Rh antibodies that are a result of Rh+ fetal blood mixing w/ Rh- maternal blood
- given at 28 wks for Rh neg mom
- given 72 hrs postpartum after fetal type/Rh
- w/ tx, very little chance of antibody production
erythroblastosis fetalis (hydrops)
•hemolytic anemia in fetus
rubella titer
- if non-immune and exposed to Rubella, can develop congenital rubella syndrome
- if non-immune vaccinated postpartum
HBSaG
- hepatitis B surface ANTIGEN indicates current infection
- surface ANTIBODIES indicate past infection/immunization
- no tx for + during pregnancy, but can vaccinate fetus w/in 12 hrs of birth to reduce risk of infection
RPR/VDRL
- syphillis labs
- tx w/ PCN during pregnancy
- redrawn at L&D admit
HIV labs
•drawn at initial and on admit to L&D •don't need pt consent •tx available during pregnancy •viral count lower than \_\_\_ means can have vag. delivery *DONT breastfeed w/ HIV
+ gonorrhea/chlamydia screened
- tx during pregnancy w/ abx and TOC w/in 1 month
* infection increases risk for preterm delivery
initial urinalysis
- asymptomatic bacteria common
* tx w/ abx if count > 100,000
HPV positive
- doesn’t affect outcome of pregnancy unless invasive cancer
* doesn’t transmit to fetus
HSV
- herpes simplex virus
- I: mouth
- II: genitals
- CANNOT have vag. delivery w/ active HSV lesions
- preventative tx during pregnancy
HGB electrophoresis
- detects hemoglobinopathies (sickle cell, etc)
* only done in high risk pts
1st trimester ultra sound
•done to confirm dates (may have to chafe EDC to match sono)
smoking effects during pregnancy
- vasoconstriction in placental leads to decreased blood flow
- placenta calcifies
- thin umbilical cord
- fetal growth abnormalities
- high risk of SIDS b/c CO2 crosses placenta
2nd trimester visits
•BP •urine dip for protein, blood, ketones, glucose, bacteria •fundal ht •leopold's •FHT (doppler) •lower extremities *every 4 wks
2nd trimester labs
- GDM screening @ 24-28 wks
- Rh antibody screening
- CBC (r/o anemia)
- genetic screening
2nd trimester ultrasound
- b/t 18-22 wks
- assess anatomical structures
- determine sex
- if high risk, sent for further evaluation
3rd trimester visit
•same as 2nd, but add in cervical exams to assess for dilation
- once get to 28 wks come every 2 wks
- once get to 36 wks come every wk
3rd trimester labs
•group beta strep (GBS)
-vaginal/rectal swabat 35-37 wks
•Rh screen if was - before
-admin Rhogam if still -
3rd trimester ultrasound
- not always performed
* offered for pt satisfaction of growth, size, etc
Who is at risk for Rh incompatibility?
•Rh negative mother w/ Rh positive fetus
fetal kick counts
•at least 3/hr
•movement peaks 9 pm and 1 am
-maternal glucose lowest
*no movement for 12 hrs is an alarm
if pt calls about no fetal movement
- tell to go eat and drink and then lie down
- should have at least 10 movements over the next 2 hours
- if < 10 movements need to bee seen for further testing
pt 34 wks, what s/sx needs followup
•headache b/c possibly have hypertension
immunizations during pregnancy
- live virus contraindicated (MMR, polio, small pox, flu mist)
- attenuated acceptable (flu, tetanus, dip, hep B, rabies)
TDAP recommendations
- vaccinate w/ EACH pregnancy
* given b/t 27-36 wks
cocooning
- vaccinating any child or adult that will have close contact w/ infant <12 months old
- immunization that protects newborn
kegel exercises
•deliberate ctx/rlx of pubococcygeus muscle to improve muscle tone/strength of pelvis
couvade syndrome
•healthy man, whose wife is expecting, experiences pregnancy symptoms
- loss of appetite
- N/V
- HA
- fatigue
- weight gain
common goal of all cultures during pregnancy
•seek to protect mom and baby
follicular phase
- variable
* before ovulation
“black box” layer of cells
- surround uterus and prevent placenta from embedding
* improvised if had cervical scrape
when do fundus measurements line up w/ pregnancy
•20 weeks
how to rule out getting mom HB instead of fetus
•take radial pulse or use pulse ox
underweight BMI
- <18.4
* should gain 27-40 lbs
normal weight BMI
- 18.5-24.9
* should gain 25-35 lbs
overweight BMI
- 25-29.9
* should gain 15-25 lbs
obese BMI
- > 30
* minimal gain
