Lecture 4+ Caring for the antepartum patient (ILA)

Question 1

Gravida

Answer 1

A term that represents the number of pregnancies a woman has had.

Question 2

GTPAL

Answer 2

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.

Question 3

Pica

Answer 3

Consuming substances not normally recognized as food, such as starch, chalk, dirt and ice. Pica is a symptom of vitamin or mineral deficiency.

Question 4

Premature

Answer 4

Term used to describe babies born prior completion of 37 weeks.

Question 5

Primigravida

Answer 5

A term used to describe women who are pregnant for the first time.

Question 6

Striae gravidarum

Answer 6

“Stretch marks” that may form during the second half of pregnancy (a normal finding).

Question 7

Term

Answer 7

Intrauterine pregnancy from the beginning of the 38th week of gestation to 42 weeks of gestation.

Question 8

Parity

Answer 8

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.)

Question 9

The length of a pregnancy is calculated beginning with _

Answer 9

The first day of the last menstrual period.

Question 10

Viability

Answer 10

The ability of the fetus to survive outside the womb. Two general criteria:

1. A gestation of 20 weeks and
2. A weight of 500 grams or greater.

Question 11

Respiratory changes during pregnancy

Answer 11

1. The diaphragm becomes elevated and the ribcage flares as the vertical diameter decreases and the anteroposterior and transverse diameters increase.
2. Breathing changes from abdominal to thoracic.
3. Dyspnea while reclining is common during the third trimester; therefore many women use an extra pillow to elevate their heads.

Question 12

Oxygen needs during pregnancy

Answer 12

1. Oxygen consumption increases by as much as 20% in the 2nd and 3rd trimesters.
2. The influence of progesterone and a 10-20% increase in respiratory rate allow the woman to meet increased oxygen consumption requirements.

Question 13

Increases in cardiac output during pregnancy

Answer 13

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%.

Question 14

During pregnancy, heart rate increases by about _ beats per minute to accommodate _

Answer 14

10-15 beats per minute; to accommodate the increased cardiac output.

Question 15

Up to 96% of pregnant women experience a _

Answer 15

Systolic heart murmur.

Question 16

Supine hypotension during pregnancy

Answer 16

1. Occurs by about 20 weeks gestation.

2. Caused by the enlarged uterus compressing on the inferior vena cava, impairing venous return.

Question 17

Two interventions for supine hypotension

Answer 17

1. Encourage the woman to lie on her side.

2. Elevate the head of the bed.

Question 18

Increases in blood volume during pregnancy

Answer 18

1. Total blood volume increases by about 40-50%; higher in cases of multiple gestation.
2. Both red blood cells and plasma volume increase, but plasma volume increases more.

Question 19

Physiologic anemia of pregnancy

Answer 19

The increase in plasma volume during pregnancy is proportionally greater than the increase in blood cells, resulting in decreased hemoglobin and hematocrit.

Question 20

Pregnancy-related weight gain

Answer 20

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).

Question 21

Role of fat stores during pregnancy

Answer 21

1. Protection against the increasing caloric demand of the fetus in later pregnancy.
2. Supply calories for lactation.

Question 22

During later pregnancy, the woman’s need for _ increases to provide for adequate fetal growth and to increase maternal hemoglobin.

Answer 22

Protein.

Question 23

Maternal anemia

Answer 23

An iron-deficiency anemia caused by the depletion of maternal stores due to the active transport of iron from the mother to the fetus.

Question 24

Nausea during pregnancy is usually caused by _ and may occur as early as _

Answer 24

Rapid hormonal shifts; 1-2 weeks after conception.

Question 25

Intervention for morning sickness

Answer 25

Instruct the woman to eat a few dry crackers prior to sitting up in the morning.

Question 26

Constipation during pregnancy is caused by decreased motility due to the effects of _ on the smooth muscle of the intestinal wall.

Answer 26

Progesterone.

Question 27

Edema during pregnancy is no longer considered abnormal, except in cases involving _

Answer 27

Generalized edema, headache, epigastric pain, visual disturbances, proteinuria, hyperreflexia, or new onset hypertension.

Question 28

Alpha-fetoprotein test - timing and purpose

Answer 28

Usually drawn at 16-18 weeks gestation. An indicator of possible fetal anomalies such as Down syndrome and neural tube defects.

Question 29

Amniocentesis - timing and purpose

Answer 29

Performed at about 16 weeks, with results available around 20 weeks. Used to diagnose chromosomal problems and detect Rh incompatibility.

Question 30

1-hour glucose tolerance test - timing and purpose

Answer 30

Performed between 24 and 28 weeks; used to screen for gestational diabetes.

Question 31

Typical frequency of antepartum visits

Answer 31

1st and 2nd trimesters - Every 4-6 weeks.

3rd trimester - Every 2 weeks, and every week during the final month.

Question 32

Ultrasound - timing and purpose

Answer 32

Performed at the beginning of the 2nd trimester to rule out fetal anomalies.

Question 33

Regarding fetal kick counts, the provider should be notified if the fetus takes longer than _ to move _ times.

Answer 33

Longer than 2 hours to move 10 times.

Question 34

A stuffy nose can occur as a result of increased levels of _

Answer 34

Estrogen.

Question 35

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

Answer 35

d. G3 T0 P1 A2 L1 (She is the only one who has completed exactly one pregnancy.)