M5 Prenatal Assessment Flashcards
Presumptive changes
(Subjective)
-breast changes, N&V, amenorrhea
Probable changes
(Objective)
- serum lab test,
Chadwick’s sign (dark bluish, purplish-red color)
Goodell’s sign (softening of the cervix)
Hegar’s sign (the uterus is being manipulated to check for tilting)
Ballottement (baby bounces back when you press on vagina)
Does a positive hCG indicate that a woman is pregnant?
No! She could have a cancer called choriocarcinoma
Positive Signs
Diagnostic
Fetal heart beat
Fetal movement palpable by examiner
Visualization of the fetus by US
Nagele’s rule
First day of LMP subtract 3 months add 7 days
McDonald’s rule
Measurement of fundal height
BETWEEN 22 and 34 weeks
Due dates are subject to errors range of about
> 2 weeks
What trimester is best for deterring accurate due date via ultrasound?
What do you look for?
First trimester bc there’s less variability
Crown rump length: 7-13 weeks
Biparietal Diameter: > 13 weeks
Femur length: > 13 weeks
What word means “number of times woman has been pregnant”
What are different terms?
Nulligravida: never been pregnant
Primigravida: pregnant for the first time
Multigravida: 2nd or any subsequent pregnancy
Para means?
Words to describe this?
Number of pregnancies after 20 weeks that were delivered
Nullipara: never bore a fetus to viable age
Primipara: woman who has completed 1 pregnancy with a fetus or fetuses
Multipara: 2 or more viable pregnancies
Term means?
38-42 weeks gestation
Nullgravida versus Nullipara
Nulligravida means a woman who HAS NEVER BEEN PREGNANT
Nullipara: a woman who has never competed a pregnancy with a fetus or fetuses to an age of viability
Preterm
An infant who is born after 20 weeks but before 37 weeks gestation
Viability
Approximately 22-24 weeks since last menstrual cycle
> 500g
The first prenatal visit will cover
History (80% of data)
Full physical exam
Counseling
When can you hear the first fetal heartbeat?
Between 8th and 12th weeks gestation
HIV exam done unless women specifically opt out
First prenatal visit
pelvimetry auscultation for fetal heart (8-12 weeks) Blood type & Rh status HIV Rubella titer Syphilis ( VDRL, RPR, STS) CBC Hepatitis B screen Pap test Cultures: Urine & STI’s Tuberculosis Test
Return visits:
Every 4 weeks until 28 weeks
(Every month for first 7)
Every 2 weeks from 28-36
Every week after 36
6 weeks postpartum checkup
What amount of alcohol or drugs is okay
NONE
Maternal pattern of weight gain?
Mom is first and second trimester
Baby is third trimester
Gaining all your weight in the first trimester is putting your baby at risk
How much folic acid do you need a day before and after pregnancy?
-400mcg
Pregnant woman high end is 600
-Most neural tube deficiencies can be prevented by getting enough B9 (folic acid)
Everyday starting before a woman gets pregnant
- bc of blood growth, need more iron (Vit. C)
-need Vit. D for baby’s bones and teeth)
-Listeriosis
Can cause Spina Bifida & Ancephaly
Listeriosis
- food-borne illness caused by bacteria
- pregnant women 13x more likely to get than General public
- antibiotics can treat infection but avoid
1) unpasteurized dairy
2) hot dogs, cold cuts unless steaming hot
3) refrigerated Pate and meat spreads
4) refrigerated smoked seafood
5) Rae & undercooked seafood, eggs & meat
Caffeine <200mg is safe
Is caffeine safe?
Yes < 200 mcg
What do you need to know about eating fish while pregnant?
- Omega-3 fatty acids important for brain development both before and after birth.
- avoid fish with high levels of mercury
Routine Prenatal Care
- weight and vital signs
- fundal height/ Leopolds maneuvers
- fetal heart rate & movement
- urine for protein, glucose, & ketones
- one-hour glucose tolerance (24-28 wks) for all pregnant women (>140mg/dL requires follow up w/ 3-hr glucose tolerance)
- Rhogram for Rh-woman at 28 weeks
- at 36 weeks vaginal & rectal swab for Group Beta Strep status
What is the nurse’s role with Antepartum fetal assessments?
1) knowledge of the tests
2) indications/uses of the test
3) meaning of the results of the test
4) how the procedure is done
5) what to prepare prior to the test
6) what to do during& after the test
7) risks/complications
8) when tests are performed during pregnancy
9) client education
Assessment of fetal wellness
1) US. 2) chorionic villi sampling
3) Amniocentesis
4) Maternal Serum Alpha-Fetoprotein (high levels AFP= NTD)
5) Non-stress Test
6) Contraction Stress Test
7) Biophysical Profile
8) Doppler Flow Studies
9) Fetal lung maturity (L/S ratio)- done with amniocentesis
10) Fetal Kick counts
Placental Previa
When the placenta is covering the cervix. Can cause bleeding
US (Ultrasound) uses all semesters
1st -determine viability, establish gestational age, determine cause of vaginal bleeding, help visualize for CVS
2nd- detect poly hydra minis/oligo
-help visualize for amniocentesis
3nd- determine placental insufficiency
- intrauterine growth restriction
- congenital abnormalities
- part of biophysical profile
Abdominal versus transvaginal ultrasound
Abdominal ultrasound- have a full bladder to lift uterus up for better imaging
Transvaginal ultrasound- involves insertion of a prove into the vagina, allowing pregnancy to be diagnosed earlier
US is costly with no health insurance
Chorionic Villus Sampling
- 10-12 weeks of gestation
- risk of fetal limb reduction of done prior to 9 weeks
- risk of spontaneous abortion
- risk of Rh sensation- need RhoGAM after
- Neural Tube Defects not detected
- earlier diagnosis
MSAFP (maternal serum alpha fetal protein)
Screening tool for neural tube defects (spina bifida)
•16-18 weeks ideally, bad calc of gestation age can cause misinterpretation
Quad Marker Screening
•free beta hCG
•unconjugated estrodial
•plasma protein A
These are screens, they are not diagnosing
Amniocentesis
Aspirate amniotic fluid for genetic analysis
•15-20 weeks •chromosome abnormalities
•used in 3rd trimester to determine fetal lung maturity when delivery prior to 38 weeks is being considered
•look at L/S ratio of 2:1 is lung maturity
-Lecithin & Sphingomyelin
•severe diabetes can cause false positive
Fetal diagnostic L/S means?
L/S: Lecithin & Sphingomyelin
Non-stress Test
Reactivity is good, you need accelerations of fetal HR in response to fetal movement
- > 15 bpm above baseline
- lasting > 15 seconds
Non-reactive Non-stress Test
Fetus could be asleep
Try to give mom/the fetus glucose to wake him up, zap the baby
After a repeat test if still not awake then do a diagnostic test (contractions stress test or Biophysical Profile)
Indication of fetal hypoxia,asphyxia, maternal illicit drug use
Disadvantages are false positive readings
Contraction stress test
Responses to synthetic oxytocin
You want NO DECELS. Finding Fetal Heart ACCELERATIONS means the test is negative (meaning the baby is fine)
Positive findings indicate there were decels, fetus will be compromised during labor
Reassures is fetus can tolerate labor
Biophysical Profile
- fetal tone
- fetal breathing movements
- gross body movements
- reactive fetal heart rate
- qualitative amniotic fluid volume
8-10/10, baby is good, no need to deliver stat
6/10 may want to consider C/s (amniotic fluid score is low)
4/10 deliver STAT
