Exam 3 Flashcards
*Establish a trusting relationship
*Develop a plan of care for the pregnancy
*Counsel and educate to ensure healthy outcomes
*Nutrition
*Weight gain
*Physical discomforts
*Drug and alcohol use
*Sexuality
first prenatal visit
Detect and prevent potential problems
*Perform comprehensive health history, physical exam, and lab tests
first prenatal visit
*Reason for seeking care
*Possible pregnancy: missed period, positive home test
*LMP?
*Signs and symptoms
*Perform urine or blood test
comprehensive health history
*Health history: past medical, surgical, personal, and family history
*Reproductive history: menstrual, obstetric, and gynecologic history
comprehensive health history
nageles rule
1st day of last period + 7 days - 3 months
*Vital signs, height, and weight
*Head-to-toe assessment
*Head and neck
*Chest
*Abdomen
*Extremities
*Pelvic Exam
Physical exam
*Assess for protein, glucose, ketones, bacteria
urinalysis
*Assess H&H, RBC, WBC, platelets
CBC
urinalysis
CBC
*Blood typing and Rh factor
*Rubella titer
*Hepatitis B surface antigen
*HIV
*RPR/VDRL
*Gonorrhea and chlamydia screening
*Additional test depending on identified risk factors
laboratory test during pregnancy
follow up visits every _____ weeks up to 28 weeks
4
follow up visits every ____ weeks from 29-36 weeks
2
follow up visits every ____ from 37 weeks to birth
week
*Continued assessments
*Weight and BP
*U/A (protein, glucose, ketones, nitrites)
*Fundal height
*Fetal movement
*Fetal heart rate
*Teaching: danger signs vs common discomforts of pregnancy
*Reinforce: nutrition, prenatal vitamin, exercise
follow up visits
screened for gestational diabetes
24-28 weeks
RhoGAM for mother who are Rh negative
and done again how long after birth
28 weeks
72 hours
GBS screening
35-37 weeks
Spotting/bleeding
painful urination
severe persistent vomiting
fever > 100F
lower abdominal pain with dizziness and shoulder pain
danger signs of first trimester
Regular uterine contractions
pain in calf
sudden gush or leaking of fluid from vagina
no fetal movement > 12hrs
danger signs of second trimester
sudden weight gain
periorbital or facial edema
severe upper abdominal pain, headache with visual changes decrease in fetal movements >24hrs
danger signs of third trimester
*Urinary frequency or incontinence
*Fatigue
*Nausea and vomiting
*Breast tenderness
*Constipation
*Nasal stuffiness, bleeding gums, epistaxis
*Cravings
*Leukorrhea
1st trimester discomforts
*Backache
*Leg cramps
*Varicosities of vulva and legs
*Hemorrhoids
*Flatulence with bloating
second trimester discomforts
*Return of many 1st trimester discomforts
*Shortness of breath
*Heartburn and indigestion
*Dependent edema
*Braxton Hick contractions
3rd trimester discomforts
*Transducer emits high frequency sound waves
*Fetal heartbeat and malformations can be assessed and measurements can be accurately made.
*Accurate dating determined up to ___ weeks
ultrasound
12
*Assessment of anatomical development _____ weeks
*Evaluate fetal size, growth, and placental position ___ weeks
Noninvasive, safe, cost effective
ultrasound
18-20
34
done early during pregnancy, used to confirm pregnancy
vaginal transducer
gets sound waves during pregnancy
can look at measurements and assess for mild formations
abdominal transducer
First ultrasound done during __ weeks confirming pregnancy and giving estimate of due date
12
*Measures the velocity of blood flow
*Detects movement of RBCs in vessels
*Detect fetal compromise in high-risk pregnancies
doppler flow studies
Pregnancies complicated by HTN or fetal growth restriction the diastolic blood flow may be absent or reversed
*Noninvasive and no contraindications
doppler flow studies
so use ultrasound -> measures blood flow of placenta from baby
Beneficial for high-risk pregnancy -> High blood pressure
doppler flow studies
when is an alpha-fetoprotein analysis performed
16-18 weeks
Measured by drawing maternal blood
False positives: incorrect dating, multiple fetuses, incorrect drawing time
alpha fetoprotein analysis
high AFP mean
open neural tube defects
gastrointestinal defects (intestine out of abdomen)
what does low AFP mean
trisomy 21 or 18 (edward syndrome)
Assess maternal blood to look at measurement of
alpha fetal protein
when are marker screening test performed
16-18 weeks
types of marker screening test
triple screen
quad screen
measured in a triple screen
alpha fetal proten
HcG
unconjugated estriol
measured in quad screen
alpha fetal protein
HcG
unconjugated estriol
inhibin A
*Enhance accuracy for down syndrome in women <35
quad screen
*Low inhibin A
low unconjugated estriol
low AFP
high hCG
concern for down syndrome
when is a nuchal translucency screening performed
11-14 weeks
*Measures the fold of the fetal neck
*Early detection of chromosomal and structural abnormalities
*Increase NT: trisomy 21, 18, 13
nuchal translucency screening
Performed by ultrasound -> noninvasive
If fold of neck is thicker and widened it would show signs of abnormalities
Also look at nasal bone for concerns of abnormalities
nuchal translucency screening
when can an amniocentesis be performed
15-20 weeks
*Collects amniotic fluid to examine fetal cells
*Confirms chromosomal abnormalities, neural tube defects, and several metabolic defects
amniocentesis
*Used at 35 weeks to determine fetal lung maturity
*RhoGAM if RH negative
amniocentesis
Collection of fetal cells by going through abdomen and collecting amniotic fluid
Can confirm abnormalities and neural tube defects
Can be done at 35 weeks -> done to confirm fetal lung maturity (looks at LS ratio to confirm surfactant production)
amniocentesis
If done earlier than 15 weeks can cause miscarriage
Invasive procedure so use sterile technique
amniocentesis
*Lower abdominal pain and cramping
*Spontaneous abortion
*Maternal or fetal infection
*Postamniocentesis chorioamnionitis
*Fetal-maternal hemorrhage
*Leakage of amniotic fluid
post amniocentesis risk
infection between placenta and fetus
amniocentesis chorioamnioitis
Collects a sample of chorionic villi from placenta
Diagnostic for chromosomal disorders
Cannot detect neural tube defects
RhoGAM if RH negative
chorionic villus sampling
Detects chromosomal abnormalities
Does not detect neural tube defects
Is invasive -> RHOGAM for RH negative, given transabdominally and trans vaginally
chronic villus sampling
Done 10-13 week of pregnancy
Transabdominal-> needle through abdomen
Trans vaginally -> Catheter through cervix
chronic villus sampling
Results available sooner: 48 hours
Earlier prenatal diagnosis to help make an informed decision about pregnancy
advantages of chronic venous sampling
*Vaginal bleeding and cramping
*Hematoma
*Spontaneous abortion
*Rupture of membranes
*Limb abnormalities
*Infection (chorioamnionitis)
Fetal-maternal hemorrhage
risks of chronic venous sampling
Doesn’t take 3 weeks like amniocentesis does
Risk for limb abnormalities because limbs not fully developed and can be affected
Done earlier in pregnancy and can confirm chromosome abnormalities
chronic villus sampling
when can you perform chronic villus sampling
10-13 weeks
when can a non stress test be performed
after 28 weeks
*Indirect measure of uteroplacental function and fetal well-being by assessing FHR
*Healthy fetus= FHR acceleration with movement
nonstress test
*Recommended for: diabetes, IUGR, preeclampsia, post-term pregnancy, renal disease, multiple gestation
Looking at accelerations in response to movement to see if baby is happy
nonstress test
*Eat before to stimulate fetal activity
*Place on left lateral: avoid supine hypotension and increase blood flow to placenta
*Time: 20-30 minutes
nonstress test monitoring
in 20 min, 2 accelerations that are 15 bpm x 15sec
reactive to NST
in 40 min 1 acceleration or no accelerations that are 15bpm x 15 sec
nonreactive NST monitoring
Within 20-40 min need at least 2 fetal accelerations
Eat before the NST
Baby would be considered reactive if there were 2 fifteen beat per minute accelerations within a 20 min time frame
Nonreactive would be no or one accelerations within 40 min
NST monitoring
Uses ultrasound and NST to assess fetal well-being
*Reduce stillbirth by early detection of hypoxia
*Time: 10-30 minutes
biophysical profile
Good for pt with high-risk pregnancy like diabetes and pre-gestational diabetes
Physical to see how baby is doing
Can detect early concerns for hypoxemia and depending on results able to intervene sooner
gives more results that NST alone
biophysical profile
BATMAN scoring for BPP
Breathing
Amniotic fluid volume
Tone
Movements
And
NST
*5 components and each worth 2 points
*2 points if criteria is met or 0 points if not met
*8/10 normal; 6 or below need further investigation
BPP scoring
> or equal to one episode of rhythmic breathing lasting > 30 seconds within 30 min
breathing
a pocket of amniotic fluid that measures at least 2cm
amniotic fluid volume
> or equal to 1 episode of extremity extension and subsequent return to flexion
tone
> or equal to 3 discrete body or limb movements within 30 min (arm, leg, torso)
movement
> or equal to 2 accelerations of 15 beats/min for 15 sec within 20-40 min
reactive NST
BPP scoring has ____ to take place
30 min
¡Increased risk in pregnancy
¡Increased needs for mother and fetus
¡Expanded maternal blood volume
Poor nutrition: iron-deficient diet
iron deficiency anemia
Complications: preterm labor, low birth weight infant, perinatal mortality, maternal hemorrhage, postpartum depression
iron deficiency anemia
fatigue
difficulty concentrating
dizziness
pale skin
headache
S&S anemia
anemic signs:
hgb <
hct <
serum iron <
11 g/dL
35%
30 mcg/dL
¡Eliminate symptoms, correct deficiency, replenish iron stores
¡Daily prenatal vitamin and iron supplements
¡Take iron with vitamin C to promote absorption
¡Take iron with meals and increase intake of fiber and fluids if GI discomforts occur
anemia management
foods with iron
dried fruits
whole grains
leafy vegetables
peanut butter
iron fortified cereals
take with iron to promote absorption
vitamin C (orange juice)
Complications: preterm labor, low birth weight infant, poor maternal weight gain, preeclampsia, iron-deficiency anemia, postpartum depression
adolescent pregnancy
Concerns for prenatal care: financial resources
Negative impact: malnutrition, infectious diseases, healthcare deficiencies, social risks
Psychosocial concerns: loss of self-esteem, social discrimination
adolescent pregnancy
Support and educate
Identify options: abortion, self-parenting, adoption, temporary foster care
Future planning: goals, return to school, job counseling
Identify barriers to prenatal care
Evaluate physical and emotional well-being
adolescent pregnancy management
Impact: fetal vulnerability, addiction, lack of prenatal care
Complications: preterm labor, abortion, IUGR, placenta abruption, fetal demise, meconium
substance abuse in pregnancy
Fetal Risk: low birth weight, decreased APGARs, neurobehavioral abnormalities, fetal anomalies, developmental concerns
substance abuse in pregnancy
fetal alcohol syndrome
alcohol
low birth weight
nicotine
cocaine
meth
