Lecture 4+ Caring for the antepartum patient (ILA) Flashcards
Gravida
A term that represents the number of pregnancies a woman has had.
GTPAL
An acronym referring to a sequence of five digits separated with hyphens commonly used in maternity centers to provide greater detail about a woman’s previous pregnancies.
G = Gravidity (total number of pregnancies).
T = Term birth (births that occurred after the completion of 37 weeks).
P = Preterm births (births that occurred before the completion of 37 weeks).
A = Abortions and miscarriages (any pregnancy that ended before 20 weeks).
L = Living children.
Pica
Consuming substances not normally recognized as food, such as starch, chalk, dirt and ice. Pica is a symptom of vitamin or mineral deficiency.
Premature
Term used to describe babies born prior completion of 37 weeks.
Primigravida
A term used to describe women who are pregnant for the first time.
Striae gravidarum
“Stretch marks” that may form during the second half of pregnancy (a normal finding).
Term
Intrauterine pregnancy from the beginning of the 38th week of gestation to 42 weeks of gestation.
Parity
The number of pregnancies in which the fetus or fetuses have reached 20 weeks of gestation, not the number of fetuses (e.g., twins) born. Parity is not affected by whether the fetus is born alive or is stillborn. (Primipara - a woman who has completed exactly one pregnancy lasting 20 weeks or longer.)
The length of a pregnancy is calculated beginning with _
The first day of the last menstrual period.
Viability
The ability of the fetus to survive outside the womb. Two general criteria:
- A gestation of 20 weeks and
- A weight of 500 grams or greater.
Respiratory changes during pregnancy
- The diaphragm becomes elevated and the ribcage flares as the vertical diameter decreases and the anteroposterior and transverse diameters increase.
- Breathing changes from abdominal to thoracic.
- Dyspnea while reclining is common during the third trimester; therefore many women use an extra pillow to elevate their heads.
Oxygen needs during pregnancy
- Oxygen consumption increases by as much as 20% in the 2nd and 3rd trimesters.
- The influence of progesterone and a 10-20% increase in respiratory rate allow the woman to meet increased oxygen consumption requirements.
Increases in cardiac output during pregnancy
1st trimester - CO increases by 1-1.5 L/min.
2nd trimester - CO increases by 1.7 L/min.
During labor - CO increases by 80%.
During pregnancy, heart rate increases by about _ beats per minute to accommodate _
10-15 beats per minute; to accommodate the increased cardiac output.
Up to 96% of pregnant women experience a _
Systolic heart murmur.
Supine hypotension during pregnancy
- Occurs by about 20 weeks gestation.
2. Caused by the enlarged uterus compressing on the inferior vena cava, impairing venous return.
Two interventions for supine hypotension
- Encourage the woman to lie on her side.
2. Elevate the head of the bed.
Increases in blood volume during pregnancy
- Total blood volume increases by about 40-50%; higher in cases of multiple gestation.
- Both red blood cells and plasma volume increase, but plasma volume increases more.
Physiologic anemia of pregnancy
The increase in plasma volume during pregnancy is proportionally greater than the increase in blood cells, resulting in decreased hemoglobin and hematocrit.
Pregnancy-related weight gain
Typically about 24 pounds, consisting of fluids, fat deposits, the increased size of the uterus, and the weight of the fetus (about 7 pounds + a 1.5-pound placenta).
Role of fat stores during pregnancy
- Protection against the increasing caloric demand of the fetus in later pregnancy.
- Supply calories for lactation.
During later pregnancy, the woman’s need for _ increases to provide for adequate fetal growth and to increase maternal hemoglobin.
Protein.
Maternal anemia
An iron-deficiency anemia caused by the depletion of maternal stores due to the active transport of iron from the mother to the fetus.
Nausea during pregnancy is usually caused by _ and may occur as early as _
Rapid hormonal shifts; 1-2 weeks after conception.
Intervention for morning sickness
Instruct the woman to eat a few dry crackers prior to sitting up in the morning.
Constipation during pregnancy is caused by decreased motility due to the effects of _ on the smooth muscle of the intestinal wall.
Progesterone.
Edema during pregnancy is no longer considered abnormal, except in cases involving _
Generalized edema, headache, epigastric pain, visual disturbances, proteinuria, hyperreflexia, or new onset hypertension.
Alpha-fetoprotein test - timing and purpose
Usually drawn at 16-18 weeks gestation. An indicator of possible fetal anomalies such as Down syndrome and neural tube defects.
Amniocentesis - timing and purpose
Performed at about 16 weeks, with results available around 20 weeks. Used to diagnose chromosomal problems and detect Rh incompatibility.
1-hour glucose tolerance test - timing and purpose
Performed between 24 and 28 weeks; used to screen for gestational diabetes.
Typical frequency of antepartum visits
1st and 2nd trimesters - Every 4-6 weeks.
3rd trimester - Every 2 weeks, and every week during the final month.
Ultrasound - timing and purpose
Performed at the beginning of the 2nd trimester to rule out fetal anomalies.
Regarding fetal kick counts, the provider should be notified if the fetus takes longer than _ to move _ times.
Longer than 2 hours to move 10 times.
A stuffy nose can occur as a result of increased levels of _
Estrogen.
Which of the following women is a primipara?
a. G3 T1 P1 A0 L2
b. G6 T0 P2 A4 L0
c. G2 T1 P1 A0 L1
d. G3 T0 P1 A2 L1
d. G3 T0 P1 A2 L1 (She is the only one who has completed exactly one pregnancy.)
