Ch 11 Assessing Fetal And Maternal Health Flashcards
Preconceptual Care assessment:
Health history
Pelvic exam
Pap test
Labs
Nurse’s role
Educate
Listen
Counsel
Typical Day and Social History for a Pregnant Patient
Nutrition
Exercise
Hobbies
Tobacco, alcohol, and drug consumption
Medication and herbal therapy
Intimate partner violence
initial interview
health history
demographic data
chief concern
family profile
Partner/Support Persons
. Encourage attendance at PN visits
. Interview separately
. Allow to express fears and concerns
. Note degree of acceptance and support
Prenatal Heath Assessment
History of past illnesses: : kidney & heart disease, hypertension, STI, diabetes, thyroid disease, varicosities…etc.
History of family illness: Cardiovascular & renal diseases, blood disorders, genetically inherited diseases or congenital anomalies
Gynecologic history: Menstrual hx, past surgeries, reproductive planning, sexual hx, stress incontinence
Obstetric history: Previous miscarriages or therapeutic abortion, number of times she has been pregnant (Gavida status), number of delivered children over 20 wks (Para status).
Physical exam:
Baseline height/weight
vital signs
Assessment of systems (Review Of Systems)
Assessment of systems
General appearance, mental status
Head, scalp
Eyes
Nose
Ears
Sinuses
Mouth, teeth, throat
Neck
Lymph nodes
Heart
Lungs
Back
Rectum
Extremities, skin
Observe for unusual findings
Hair little and dry (nutrition)
Eyes swollen, diplopia (PIH)
Swollen sinuses (no OTC)
Fullness in the ear
Nose congestion
Mouth: gingival hypertrophy
Teeth with dental caries
Supernumerary nipples
Functional heart murmur
Scoliosis
Rectum/ hemorrhoids
Extremities, skin: Itching, varicosities.
Assessment of uterine growth and fetal status
Fundal height
with measuring tape from symphysis pubis to the uterus
Fetal heart rate
doppler 10 - 12 weeks
sthetoscope 18 - 20 weeks
normal fetal heart rate 110 - 160 beats/min
pelvic exam:
areas
position
equipments needed
External genitalia
Internal genitalia
Vaginal inspection
Exam of pelvic organs
Pap smear
Lithotomy position
Equipment needed:
Speculum (movable flat blades)
Lubricants
Clean gloves
Spatula for cervical scraping
Glass slide (or liquid collection) for Pap smear
Sterile cotton applicators for cervical cx
Pelvic Exam External organs:
Assess external genitalia (Vulva, vagina, Bartholin glands) for any infection, ulcerations, lesion, vaginal discharge
Hypertrophy of the Labias and clitoris normal during pregnancy
Vulva
Herpes simplex
Bartholin glands
=> streptococci, gonorrhea
Pap smear
Precancerous or cancerous condition of the uterine cervix, vulva, or vagina or infection
labs
CBC, Hg/Hct- Blood type, RH 1st visit
Genetic screen (sickle cell, thalassemia)
VDRL (syphilis), HIV- (1st trimester)
Maternal Serum for-Alpha-fetoprotein MSAFP (16-18 weeks)
Antibody titers for rubella and hepatitis B (1st visit)
1hr glucose loading test: GTT at 28 weeks
Screening Ultrasound at every visit
Group B Streptococcus (1st visit &35-37 weeks)
U/A by dipstick- at every visit
Frequency of Visit
Nulliparous-uncomplicated pregnancies:
Every 4 weeks until 28 weeks of gestation
Every 2 weeks, from 28 - 36 weeks
36 on, weekly until delivery
Women with problems: seen more frequently
the pelvis: parts and cavities
Made up of immovable bones
Pubic arch anterior
Sacrum posterior
Sacrococcygeal joint can move slightly
Divided into: The false pelvis & the true pelvis
Other terms used:
Inlet is the entrance of the true pelvis
Outlet is the inferior portion of the pelvis
Pelvic cavity is the space between the inlet and the outlet
Pelvic Size
Once baby enters pelvis must exit through the outlet
Widest part of inlet is
transverse diameter
Widest part of the outlet is
AP diameter
Pelvic cavity is curved
slowing birth and
preventing head trauma
It is tight to help expel
fluid and mucus
pelvic types
android: fetus facing difficulty to exit such a pelvis
anthropoid : => transverse diameter is narrow, anteroposterior
larger than usual => difficulty to exit
gynecoid : oval inlet, anteroposterior diameter is shallow
platypelloid : well rounded forward and backward, wide
pubic arch => ideal for childbirth
Estimating Pelvic Size
Type
Measurements
Diagonal conjugate
Ischial tuberosity
It reveals the diameters of the inlet and the outlet
This assessment is done during last weeks of pregnancy
1- Measure diagonal conjugate
From sacrum to symphysis
AP diameter of inlet > 12.5 cm
adequate
2 - Measure Ischial tuberosities
Distance between the ischial tuberosities
Transverse diameter of outlet
>11cms is adequate
Calculating Delivery Date using Naegele’s Rule
Expectant Date of Delivery (EDD) =
First day of the last Menstrual Period (LMP) – 3 months + 7 days
gestational wheel
para:
primipara :
multipara:
the number of pregnancies that have reached viability regardless or whether the infants were born or not
first pregnancy
two or more
gravida
primigravida
multigravida
nulli gravida
a women who is or has been pregnant
pregnant for the first time
has been pregnant previously
has never been pregnant and is not pregnant currently
Example 1:
Hala is pregnant with her third child. Her first pregnancy ended in a miscarriage at 16 weeks. Her second pregnancy she delivered a baby at 32 weeks. What is her GPTPAL?
Answer: G3, P1, T0, P1, A1, L1
Example 2:
Sawsan has just delivered term twins. She also has, at home, a 2 year old boy delivered at 42 weeks and a 6 year old girl delivered prematurely at 35 weeks. Ten years ago she had a miscarriage at 22 weeks.
What is her G,P? What is her TPAL?
Answer: G4, P4, T2, P2, A0, L4
