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anterpartal Flashcards

1
Q

Antepartal Care

A

Purpose: to have mother arrive at end of pregnancy
in good health and to deliver healthy baby

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2
Q

PRESUMPTIVE signs

A

subjective information/Reported by patient

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3
Q

examples of presumptive (6)

A
  • AMENORRHEA (absence of menstruation)
    ◦ d/t increased estrogen

-NAUSEA / VOMITING
◦ Common week 2-12

-FATIGUE

-BREAST CHANGES (tenderness, tingling,
increase vascularity, enlargement)
◦ d/t increased prolactin, week 2-3

-FREQUENT URINATION
◦ Pressure of enlarging uterus on
bladder

-Quickening
– feeling of life – mother thinks
she feels baby move, feels like a flutter
Primipara – felt @ 18-20 weeks
Multipara – felt @ 14-16 weeks

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4
Q

PROBABLE SIGNS ( who determines ..)

A

objective signs of pregnancy (physiological and anatomical) perceived by HCP

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5
Q

PROBABLE SIGNS examples (9)

A

Vaginal :
- Chadwick sign
blueish-purple coloration of vaginal mucosa, cervix and vulva seen at 6 to 8 weeks

  • Goodell signs
    softening of cervix with increased leukorrheal

Uterine :
Hegars Signs
softening of uterine segment

BRAXTON / HICKS
CONTRACTIONS
◦ 16 weeks/Uterus contracting, tightening
Intermittent, painless,
irregular

-BALLOTMENT
◦ Palpation with rebound
(16-18wks)

-PREGNANCY TESTS Depend on HCG
-Linea Nigra -dark
line from umbilicus to
pubis
-Nipple and areola -
darker in color
-Melasma
o “mask of pregnancy”
brownish pigmentation
on foreh

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6
Q

Chadwick sign

A

blueish-purple coloration of vaginal mucosa, cervix and vulva seen at 6 to 8 weeks

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7
Q

Goodell signs

increased _____

A

softening of cervix with increased leukorrheal

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8
Q

Hegars Signs

A

softening of uterine segment

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9
Q

BRAXTON / HICKS
CONTRACTIONS

A

16 weeks/Uterus contracting, tightening
Intermittent, painless,
irregular

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10
Q

BALLOTMENT

A

◦ Palpation with rebound
(16-18wks)/ technique of feeling for a movable object in the body, esp confirmation of pregnancy by feeling the rebound of the fetus following a quick digital tap on the wall of the uterus.

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11
Q

-Linea Nigra -dark

A

line from umbilicus to
pubis

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12
Q

Melasma

A

o “mask of pregnancy”
brownish pigmentation
on forehead

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13
Q

PREGNANCY TESTS
1. HUMAN CHORIONIC GONADOTROPIN
(HCG)
Urine becomes positive _____wks after
conception

  1. ______________ = Highest concentration level of HCG
  2. INACCURATE RESULTS (4)
A

PREGNANCY TESTS
HUMAN CHORIONIC GONADOTROPIN
(HCG)(found in blood or urine)
◦ Produced by chorionic villi
◦ Urine becomes positive 4wks after
conception

FIRST AM URINE
◦ Highest concentration level of HCG

INACCURATE RESULTS (not 100% accurate)
◦ Improper specimen collection
◦ Medications
◦ Hormone-producing tumors
◦ False-positive, false-negative makes it a
probable sign

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14
Q

POSITIVE SIGNS

A

FETAL HEART TONES (audible by 10wks
with doppler)

Observation and palpation of fetal
movement (20wks)

ULTRASONIC VISUALIZATION (presence
of fetus)(cardiac movement at 4-8wks)

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15
Q

NAGELE’S RULE for expected date
of delivery
USED TO CALCULATE
EXPECTED DATE OF Delivery
(EDD)

A

First Day of LMP – 3 months + 7
days

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16
Q

factors influence accuracy of nagele

A
  • regularity of cycle
  • length
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17
Q

1st trimester:

when

A

1st day of last menstrual period through 14th completed weeks

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18
Q

2nd trimester: __wks – ___completed weeks

____ testing for and adminstration of _______

A

Urine testing for glycosuria and proteinuria (screen for
gestational diabetes at 24-28wks

@20wks at umbilicus

  • administration of RHOGAM
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19
Q

3rd trimester:

what test is being done

A

29wks – 40 completed weeks

Group B streptococcus

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20
Q

Warning signs in first trimester ( 7)

when to notify hcp

A
  • abdominal cramping
  • vaginal spotting/bleeding ( can be abortion)

-absence of fetal heart rate

  • dysuria, frequency, urgency = UTI
  • fever/chills
  • prolonged nausea and vomiting (hyperemesis)
  • Pre-eclampsia: severe continuous headache, edema
    of face, hands and legs in the morning, scanty
    concentrated urine, visual disturbances – flashes of light or
    dots, dimness, blurring
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21
Q

Blood work and cultures

A

CBC –Hgb, Hct, RBC, WBC, Platelets

Sickle cell trait (prn), genetic screening

Rubella titer, Hepatitis B

Blood group – Rh factor, Coombs’ test, Blood type

 Rh incompatibility

 Detects other antibodies for incompatibility with
maternal antigens

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22
Q

Glucose screening

A

1 hr GTT if ≥130 mg/dl  will do 3 hr GTT
◦ HRF: screen @ 1st prenatal visit
◦ Lower risk: 24 – 28 wks

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23
Q

*Chorionic villus sampling (CVS)- Chorionic villus sampling (CVS)

A

aspiration
of sm. amt placental tissue (chorion) for
chromosomal analysis. Done at 10-13wks. Fetal
abnormalities d/t genetic disorders.

◦ Removal of small tissue specimen
from fetal portion of placenta
Tissue reflects. genetic makeup of fetus

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24
Q

Percutaneous Umbilical Blood Sampling
(PUBS) –

A

removal of sample fetal blood from
umbilical cord. Test for metabolic and
hematological disorders, fetal infection. Done
after 18wks.

  • Direct
    access to fetal circulation
    Insertion of needle directly into a fetal umbilical
    vessel under ultrasound guidance
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25
Amniocentesis
Needle inserted thru abdominal wall to obtain sample of amniotic fluid. Used for genetic testing, hemolytic fetal disease, and assessment of fetal lung maturity.
26
Amniotic fluid Produced from amniotic membrane the ____ trimester, then produced by _______ 2nd and 3rd trimester. Fluid volume peaks at 34 weeks _________ml then decreases to ____________
 Clear, composed of water, proteins, CHO, lipids, electrolytes, fetal cells, lanugo & vernix caseosa.  Produced from amniotic membrane the 1st trimester, then produced by fetal kidneys 2nd and 3rd trimester.  Fluid volume peaks at 34 weeks 800-1000ml then decreases to 500-600m
27
OLIGOHYDRAMNIOS= ____ ml | Renal agenesis DEFINE..think about fetal function organs
Amniotic fluid less than 300 ml leading to fetal anomalies/ renal agenesis Renal agenesis- meaning failure of the part/system to form
28
Polyhydramnios
 Amniotic fluid excess amount 1500-2000ml  Increase risk of chromosomal disorders, gastrointestinal, cardiac and/or neural tube disorders.
29
vitamin b6 purpose
helps process certain amino acids to reduce nausea
30
Non-electronic fetal monitoring  Daily fetal movement count (DFMC) –
maternal assessment of fetal movement by counting movement/period of time: 4movements/1hour = positive
31
Ultrasonography
◦ Indications for use ◦Maternal uterine structure/placenta location ◦Fetal heart activity, blood flow ◦Gestational age ◦Fetal growth, anatomy, congenital anomalies ◦Amt of amniotic fluid ◦Assistive with other invasive tests –CVS, PUB,amniocentesi
32
Magnetic resonance imaging (MRI)
◦ Examiner evaluates:  Maternal structures (uterus, cervix, adnexa, and pelvis) Biochemical status of tissues and organs Soft tissue, metabolic, or functional anomalies  Most common performed for suspected brain abnormality  Further evaluate abnormal placentat
33
Electronic Fetal Monitoring Non-stress test (assess fetal condition/well being) fetal HR Vibroacoustic stimulation- Contraction stress test (CST)-
Non-stress test (assess fetal condition/well being) fetal HR increases in response to movement (normal) - Procedure-use external monitor for 20-40mins assessing FHR with each movement on a contraction strip ◦ Interpretation: reactive vs. nonreactive Vibroacoustic stimulation- used with nonreactive NST, use auditory stimulation to assess fetal well-being. Create artificial sound on maternal abd. Contraction stress test (CST)- assessment of fetal response to intermittent reduction in utero placental blood flow r/t stimulated uterine contraction
34
Reactive Nonstress Test (NST)
n NST is reassuring or reactive when the fetus' heart rate accelerates (increases) when it moves or when you have a contraction
35
1st trimester discomforts cont’
Breast changes -tenderness, enlargement; wear well-fitting supportive bra Emotional changes –fluctuation in emotions r/t hormones; communicate with family and friends, TCT Fatigue –plan for extra rest time, adequate calorie intake, iron-rich foods, prenatal vitamins Faintness/dizziness –hydration, avoid standing for long periods, rise slowly from sitting to stan
36
Discomforts 2nd Trimester | think about the burn.... AND LOWER HALF
Heartburn – eat small freq. meals, remain upright for 30-45 after eating, Constipation /flatulence –adequate fluid intake, fiber, exercise as tolerated Muscle cramps /leg spasms –Dorsiflex foot to stretch calf muscles. Vaginal discharge –encourage daily bathing, use cotton underwear, wear panty liners, notify MD if change in color or odor may indicate infection
37
chorionic villus sampling
(CVS) prenatal test checks cells from the placenta (which are identical to cells from the fetus) to see if they have a chromosomal abnormality (such as Down syndrome
38
2nd trimester… | issues
Nosebleeds (Epistaxis) –Use cool air humidifier, nasal saline gtts Headaches –maintain adequate hydration Increased salivation –use gum or hard candy Heart pounding –cardiac output increases 30- 50%, HR increases 15-20 beats/min Pelvic discomfort –Side lying, maternity girdle, firm mattress with pillows, supportive shoes, pelvic rock/tilt exercises Emotional changes – adequate rest and nutrition, pregnancy support group
39
Supine hypotension.
Note relationship of gravid uterus to ascending vena cava in standing posture (A) and in supine posture . C, Compression of aorta and inferior vena cava with woman in supine position. D, Relieved by use of a wedge pillow placed under woman’s side
40
3rd Trimester | notify hcp
Braxton Hicks Contractions – call MD if contractions become regular and persist before 37wks. Ensure adequate fluid intake, maternity girdle for uterus support  Varicosities –legs, vagina/vulva, hemorrhoids – result of increase venous pressure. Girdle to support uterus and thus reduce venous pressure, support hose, avoid prolong sitting or standing, elevate legs, position on side when lying down, avoid crossing legs, Avoid straining with BM, witch hazel pads Bleeding gums – soft toothbrush, oral care Fatigue – rest periods Insomnia –relaxing bedtime routine, naps Emotional changes –communication with S.O., prenatal classes, support group
41
Lower extremity edema – | what to do
elevate legs, sidelying, dorsiflex periodically when standing or sitting, maternity girdle
42
Lamaze:
*Introduced early 60’s *highly structured system includes conditioning, discipline and concentration *Having a coach to assist with system
43
1st trimester: | what does this signfies" "
acceptance of pregnancy “I am pregnant”
44
 2nd trimester: | ". "
growing fetus distinct from mother “ I am going to have a baby”
45
 3rd trimester:
preparing for baby “ I am going to be a Mom”
46
Takes ___________________calories to support growth and development of the fetus –translates to ___________ extra calories/day throughout pregnancy
80,000 300
47
Pica:
abnormal craving for non-food items (clay, laundry starch, cornstarch)
48
Pagophia:
excessive ice eating (may be related to iron deficiency)
49
Underweight:
anemic, fatigue, poor eating habits, depression
50
Overweight:
may need to reduce calorie intake, HT healthy choices
51
Teenage pregnancy:
general diet usually inadequate (low in iron, calcium, vit A and C), low birth weights, nutritional needs also r/t growth and maturation of mother, need 2400 – 2700 calories daily
52
Risks associated with GDM | mother and baby
* 2x risk of HTN disorders, Preeclampsia, Preterm labor, Spontaneous abortion, C-section delivery, Post partum hemorrhage\ Fetal macrosomia  lacerations, episiotomies, c/s, shoulder dystocia and birth trauma * Neonate @ risk of hypoglycemia, hypocalcemia, hyperbilirubinemia, thrombocytopenia, polycythemia, and RDS
53
1st Trimester - | LEVELS
 estrogen & progesterone   insulin production Mom prone to hypoglycemia
54
2nd & 3rd Trimester -
 placental lactogen, estrogen, progesterone  insulin resistance in Mom Allows glucose supply for fetus
55
Mom’s insulin requirement increases ___________ gest. wks
18 – 24 wks
56
Testing –
GTT (glucose tolerance test) Blood sugar measurements –daily am fasting, 3 pre/postprandial checks/day HBG A1C –want to keep it < 7% Urine ketones when BS >200 mg/dL
57
_______________ agents used in Type 2 stable diabetics and gestational diabetics
Oral hypoglycemic
58
Preeclampsia | DEFINE/RISK FACTORS/S &S
 Hypertension, multisystem disorder in pregnancy  Cause unknown, possible placental issue  Risk factors: nulliparity, age <19 or >35, obesity, multiple gestation, DM, dx of hypertension or renal disease  Reduced organ perfusion d/t vasospasm affects hepatic system, renal system, coagulation, central nervous system, eyes, fluid/electrolytes, pulmonary system  S/S: elevated BP (>140/>90), persistent headache, visual disturbances, right upper quadrant or epigastric pain, elevated liver function test, diminished kidney functioning, altered clotting, facial edema
59
Treatment of Preeclampsia | MEDICATIONS (2) / ASSESS FOR WHAT/ MONITOR
Monitor weekly - VS  Administer antihypertensives: Hydralazine, Labetalol  Administer Magnesium sulfate IV or IM (reduce seizure activity in labor and delivery)  Assess lung sounds, RR, SOB, chest tightness, cough, POX Monitor for CNS changes (headache, visual changes, deep tendon reflexes), keep quiet environment Activity restrictions (bedrest), monitor urinary output
60
Abortion:
Spontaneous or elective termination of pregnancy prior to 20 weeks
61
Referred to as induced abortion
(medical/surgical termination before fetal viability)
62
elective abortion | ELECTIVE... WHEN WE VOTE...
(at the request of the woman)  Elective abortion: early termination of pregnancy at request of the woman
63
therapeutic abortion
serious maternal medical issues or fetal anomalies) Therapeutic abortion: performed to save the mother’s life or serious fetal anomalies
64
spontaneous abortion
(occurs without medical or mechanical means-miscarriage)
65
Abortion procedures: * First trimester: Medication procedure * Second trimester:
(mifepristonemisoprostol) or Suction curettage/vacuum aspiration Dilation and Evacuation surgery
66
Cerclage correction in Threatened abortion
cervical cerclage is a treatment that involves temporarily sewing the cervix closed with stitches. This may help the cervix hold a pregnancy in the uterus. A cerclage is done in the second trimester of pregnancy to prevent preterm birth
67
Ectopic Pregnancy
S/S: missed 1 menses, Prior to tubal rupture: pelvic or abdominal pain, abnormal bleeding. After tubal rupture: sever lower abdominal pain ( usually onesided), sharp pelvic pain, stabbing, tearing, unstable VS, referred shoulder or neck pain  Diagnosis: rule-out (r/o) ovarian cyst, appendicitis, + pregnancy test, endovaginal ultrasound
68
LAPAROTOMY:
Salpingectomy ◦ Removal of tube and remainder of products of conception
69
LAPROSCOPY:
Salpingostomy ◦ Tube opened and embryo removed; ◦ tube left to heal ◦ (HRF more scar tissues)
70
Non-surgical: ectopic preggy | medication
administer Methotrexate (folic acid antagonist and type of chemotherapy agent) cause dissolution of the ectopic mass
71
Gestational Trophoblastic Neoplasms – rare complication
Benign or malignant tumors that arise from the trophoblast of human pregnancy (no fetus, no amniotic sac, no placenta)
72
Types: of neoplsmas
Hydatidiform mole (benign-most common), Chorioadenoma destruens, Choriscarcinoma
73
Hydatidiform Mole:
grape-like clusters, early s/s of pregnancy, partial involvement= limited due to some chorionic (fetal) tissue, complete involvement = no embryonic tissue or membrane
74
 Complete Hydatidiform Mole:
dark brown-bright red vaginal bleeding, occurs 6-8 weeks post missed menstrual cycle, large uterine size, ovarian enlargement, abdominal cramping, Hyperemesis Gravidarum, Gestational Hypertension
75
Treatment for Hydatidiform Mole | howlong to wait till next preggy
Suction curettage to evacuate a molar pregnancy  Hospitalized to monitor closely for hemorrhage (observing for DIC and HELLP syndrome)  Pitocin infusion for 24 hours after surgery to control bleeding  hCG levels monitored  Contraceptives for one year or if complicated hysterectomy recommended – Oral or diaphragm recommend
76
Placenta Previa
= implanted in the lower segment close to cervical os/ When the placenta covers the opening in the mother's cervix.
77
Placenta Previa cont’  Risk factors:
Endometrial scarring (hx of placenta previa, previous c-section, suction/curettage for miscarriages or induced abortions, multiple gestation), maternal age >35, hypertension, smoking, diabetes, uterine anomalies
78
Symptoms: of Placenta Previa
painless bright red bleeding after 7th month, suspected if bleeding after 20 weeks,  Diagnosis: ultrasound to locate placenta
79
Treatment of Placenta Previa : Early pregnancy: vs Late pregnancy:
Early pregnancy: bed rest to allow for fetal lung maturity, no intercourse, monitor VS and FHR, daily Hgb and Hct, have blood available, may do vaginal delivery if less than 30% of os is covered  Late pregnancy: C-section delivery
80
Abruptio Placenta Separates prematurely ( after_____ wks)  Biggest risk factor-
Separates prematurely ( after 20 wks)  Biggest risk factor- hypertension  Other risk factors: cocaine/methamphetamine use, blunt abdominal trauma, smoking
81
Diagnosis made by s/s: Abruptio Placenta
severe sudden onset of intense uterine/abdominal pain, severe bleeding (dark, almost purple), board-like abdomen(hypertonic uterine contractions), FHR low or absent
82
Abruptio Placenta complications
 C-section delivery  Severe bruising of uterine muscle that leads to impossible contraction = hysterectomy  Hemorrhage  DIC  Hypovolemic shock > pituitary necrosis > renal failure  Fetal hypoxia, preterm delivery, stillbirth or anoxia or death
83
Nursing care of placenta previa and abruptio placenta
Comprehensive history of onset Last vaginal exam, ultrasound results Vital signs ( hypotension, tachycardia) Lab tests: Hgb, Hct, CBC, clotting factors, chemistry (CMP) Monitor fetal heart rate, apply oxygen on Mom (8- 10L/min via mask) Assess uterine tone/contractions, vaginal bleeding, abdominal pain
84
pt care for abruptio
NPO ( nothing by mouth), insert foley catheter( decreased renal output) IV insertion (large needle 18 gauge) Semi-fowler’s position Prepare for C-section Support parents
85
HELLP syndrome
With hemolysis of RBC: fatigue, pallor, anorexia, weakness, lassitude, dyspnea, edema, Hgb less than 6, decrease O2 to the baby, increase risk of fetal stillborn and premature newborns * With elevated liver enzymes: nausea/vomiting, malaise, right upper quadrant pain from liver distention, hyperbilirubinemia * Unexplained bruising & petechiae
86
Infections  STI/STD  TORCH infections  Group Beta Streptococcus (GBS) p  Zika virus p. 212-  Coronavirus (Covid-19)  Human Immunodeficiency Virus (HIV)
Infections  STI/STD p.206 –Chlamydia & Gonorrhea cause ophthalmia neonatorum in birth canal during delivery  TORCH infections p.209 (Toxoplasmosis, Other, Rubella, Cytomegalovirus & HSV) cross placenta and affect developing fetus.  Group Beta Streptococcus (GBS) p.211- risk of premature labor, newborn neurological issues  Zika virus p. 212- mosquito bites, foreign travel, cause birth defects, IUGR, miscarriage or stillbirth  Coronavirus (Covid-19) p.212- pregnant increases risk for severe respiratory manifestations, preterm delivery,  Human Immunodeficiency Virus (HIV) p.204-destruction of CD4 T cells in immune system, Transmitted transplacental, intrapartal & breast milk. Risk preterm delivery, preterm ROM, IUGR

nur 112 (23 decks)

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