maternity week 2 Flashcards
morning sickness, heartburn, etc. cause
unknown, likely hormones
how many ppl plan to get pregnant?
about 50%
main issues w/ pregnancy (the usual)
HTN and diabetes
what is purpose of prenatal care?
Purpose of PNC: To reduce risks to pregnant person and fetus.
Routine assessments and screenings that increase in frequency.
Individualized counseling related to diagnoses and prenatal testing.
Patient education.
Individual vs. Group setting
CENTERING PREGNANCY® PRENATAL CARE
Evidence-based model
Group visits w/ pregnant people w/ similar EDD
Improves health outcomes/reduces disparities
Greatest impact for Black childbearing people
Often CNM led (best for Black community)
prenatal scheduled visits (one, a month to 28 days, 2 weeks to 36, then weekly)
- First visit within the first trimester (12 weeks)
- Monthly visits weeks 16 through 28
- Every 2 weeks from weeks 29 to 36
- Weekly or bi-weekly visits week 36 to birth
baby is viable at
24 weeks
if bleeding in the middle of the night before 24 weeks, go to
labor and delivery
midwife vs doctor
can have medication with both
first prenatal visit
Confirm pregnancy: Blood or urine pregnancy test
Determine Estimated Due Date (EDD - estimated due date), EDC, EDB - same thing)
Screening exams: blood tests, weight/BMI, urine dip, STI tests, full physical assessment/pelvic exam
Health Baseline: Baseline VS, reproductive history, medications, substance use, nutritional status, comorbidities (including age) (Ricci p. 370, Fig12.2, Health History Summary)
Comprehensive history taking: Family structure, psychosocial risk factors (Ricci p. 366, Fig. 12.1: Preconception screening tool)
urine
checking protein, glucose, specific gravity,
nagele’s rule
Last Menstrual Period (LMP)
Plus 7 days
Minus 3 Months
= Estimated Due date
stress test at when? (Stressed not quite at 28 weeks later)
24 weeks and above
at least 15 bmp
above the baseline for 15 min (stress test, look this up in the book)
BPP
NST, breathing movement, fetal tone, fetal movements
follow up visits
Weight tracking
Assessment physical and emotional well being
VS/BP
Urine checked for protein, glucose
Additional blood tests PRN
Education
Additional tests 2nd/3rd tri: GBS, Gestational Diabetes Screening
Rhogam (immunoglobulin) PRN
Planning for birth/preferences - usually 3rd trimester - pain management at birth, etc.
Genetic Testing
RH test**
COOMBs test - anytime the blood is mixed with RH - mom, will get a coombs test.
follow up visits - fetus
Fetal growth: fundal height
Fetal wellbeing subjective: FHR via U/S or doptones
Fetal wellbeing subjective: fetal movement (a “VS”) - (quickening) - fist baby 20 weeks, 2nd - 12 weeks
Genetic Screening exams/results
fundal height at what time
12-14 weeks (check this)
potential complications
Infection: All trimesters
Spontaneous Abortion (SAB)/Miscarriage: 1st
Hyperemesis: All trimesters
Pyelonephritis: All trimesters
IUFD: 2nd/3rd tri
Kidney Stones: All trimesters
Gestational Diabetes: 3rd tri (but could be
earlier)
PPROM: 2nd/3rd
Hypertensive disorders: All trimesters
pylonephritis main symptom
pain
hypertension++ what is the number? (The normal number)
140/90
Hypertensive Disorders of pregnancy - death++
Hypertensive Disorders of pregnancy 2nd leading cause of morbidity.
3rd Trimester Testing:
Group B Strep++
Vaginal/Rectal Swab at 35-37 weeks
Considered GBS+ if urine contains GBS in first tri
Affects 50% of pregnant people
GBS normal vaginal flora
GBS+: ABX prophylaxis in labor
rhogam - dose (rhogam costs $300)
300 mcg IM, deltoid
interventions for morning sickness
Eat dry carbs in AM before getting up
Avoid empty stomach/eat small frequent meals
Avoid: strong smelling foods/fatty, fried foods
Ginger
Vit B6, & doxylamine (unisom), or Zofran may be prescribed
PNV to maintain adequate nutrition
physical changes - Round ligament pain (my stomach is round)
abdominal pain. 2nd and 3rd trimester a lot of abdominal pain. (exercise and belt for patients)
sexual changes***
no problem having sex during pregnancy.
only time sex can be harmful is…
if pt has history of preterm labor.
MMR and varicella -can you give during pregnancy?
given during pregnancy bc they are live vaccines.
genetic screening
Screening test vs. Diagnostic Tests
Screening for neural tube defects, trisomy 21 and other chromosomal abnormalities.
Screening tests may be followed by diagnostic tests.
Individual counseling based on risk factors/beliefs/preferences to guide decision-making.
screening tests lower risk, diagnostic higher risk
earliest test - Cell-free fetal DNA: 8-10 weeks
Blood draw from pregnant person
Detects fetal cells in maternal circ
High sensitivity to Tri 21 (99.9%)
diagnostic - Amniocentesis
Amniocentesis:
15-20 wks gestation (may be done 11-14 w/ higher SAB risk.
Risk of SAB similar to CVS
Amniotic fluid anayzed for chromosomal abnormalities, infection, Rh sensitization
3rd tri: used to test for lung maturity
diagnostic - Chorionic Villus Sampling (cronion is early, it’s genetics)
Chorionic Villus Sampling:
10-13 wks of gestation
Placenta specimen obtained trans-abd. or trans-vag.
Genetic material analyzed for common chromosomal abnormalities.
Does not detect neural tube defects.
Risks: damage to structures, 0.5-1.0% risk of miscarriage (SAB).
Excessive intake - how big will the baby be? (The baby weighs 4000 tons)
baby over >4000 grams
more at risk for malnutrition during pregnancy
- Adolescence or less than 2 years post menarche
- Frequent pregnancies: three within 2 years
- Poor fetal outcome in a previous pregnancy
- Poverty/food insecurity
- Poor diet habits with resistance to change
- Use of tobacco, alcohol, or substances
- Weight at conception under or over normal weight
- Problems with weight gain
- Weight loss during pregnancy
nutrtional risk during pregnancy - what weight gain is dangerous?
Weight gain of more than 3 kg (6.6 lb)/month after the first trimester
Weight gain of less than 1 kg (2.2 lb)/month after the first trimester
Multi-fetal pregnancy
Low hemoglobin and/or hematocrit values (biochemical measure
Diabetes
Chronic illness, including an eating disorder, that affects intake, absorption, or metabolism of nutrients
nutritional assessment
Anthropometric: obtain baseline and serial weight/BMI
Obtain diet record
Review supplement intake
Formulate individualized plan of care based on objective/subjective data
Education on food choice/calorie intake: additional 300 kCal (2nd/3rd tri.)
Physical assessment: head to toe/signs of malnutrition?
calcium - what nut has it?
Sources: dairy, almonds, canned fish, dried beans/lentils
folic acids (black eyed peas on acid)
Leafy greens, black-eyed peas and other legumes, citrus, peanuts, liver
Deficiency: risk for NTD
iron
Animal meats, leafy greens, eggs, tofu, tempeh, fortified foods (but whole foods are better)
Vit C aids absorption
Low iron=anemia
folic acid*****
Necessary for RBC formation
risk of NTD (neural tube defect)
People who may become pregnant should take supplement
alcohol*****
No safe amount in pregnancy
Artificial Sweeteners
Unknown effects: may be linked to higher birthweight/childhood obesity
No nutritional value
mercury
May lead to pregnancy complications & childhood developmental delays
Limit fish to 2x/week & avoid fish higher in mercury
Listeriosis
Unpasteurized & raw foods, deli meats, refrigerated smoked fish, deli salads, “old” food, poorly refrigerated
May pass through placenta
Risk of miscarriage, stillbirth, neonatal demise
Psychological Adaptation to Pregnancy: Stages
(1st - 3rd trimester)
Ambivalence
Introversion
Acceptance
Psychological Adaptation to Pregnancy: 2nd trimester
Establishing a relationship with the fetus
Fetal movement/fetus as separate being
Pregnancy/fetus main focus
Attention to own mother and others who are pregnant (more outward focus)
Psychological Adaptation to Pregnancy: 1st Trimester
Introversion: Focus on self.
The baby isn’t real
Ambivalence: Examines what needs to be given up
Emotional lability
Change in body image.
Psychological Adaptation to Pregnancy: 3rd Trimester
Tired of being pregnant
Prepares realistically for the birth and parenting
May be unconfident about parenting
Identifying with the mother/parent role
Reordering of relationships
