Nursing management during pregnancy

Question 1

What are the three phases of pregnancy?

Answer 1

Antepartum, before birth
Intrapartum, during labor and birth
Postpartum, after birth

Question 2

What occurs during the subsequent visits to the HCP by a pregnant woman?

Answer 2

Weight, vitals (looking for new onset hypertension). Urine dip stick for protein, ketones, glucose. Final height, fetal heart tones, fetal movement assessment, edema as the pregnancy progresses. Questions about early contractions or preterm labor.

Question 3

What is checked at an HCP visit during weeks 24-28?

After 37 weeks?

Answer 3

24-28 is the glucose challenge test, earlier with risk factors. If abnormal, a 3 hour glucose challenge test is done.
37 screening for group B strep, chlamydia, and gonorrhea.

Question 4

Blood typing and Rh factor lab?

Answer 4

Risk of isoimmunization if the mother is Rh(-). Risk of ABO incompatibility if the mother is type O and the infant is anything other than type O.

Question 5

Rubella titer lab?

Answer 5

< or equal to 1:8 titer needed pre-pregnancy or post part vaccination. Transmitted transplacentally.

Question 6

Hep B surface antigen (HbsAg) lab?

Answer 6

If the mother is HbsAg positive. Hep B vaccine and hep B immune globulin (HGIB) within 12 hours given to the baby, can breastfeed once immunized.

Question 7

Group B strep lab?

Answer 7

Requires treatment during labor with penicillin. If untreated, baby can become infected and be seriously ill.

Question 8

Any pregnancy the woman has had including the current one, regardless of outcome.
Any delivery greater than or equal to 20 weeks.
Any delivery less than or equal to 20 weeks.

Answer 8

Gravida
Para (deliveries)
Abortion. Spontaneous abortion (SAB) and induced abortion (EAB)

Question 9

What does a short obstetric history include? Long?

Answer 9

Short includes gravida and para (G/P).

Long describes what happened each pregnancy. GTPAL

Question 10

GTPAL?

Answer 10

G: all pregnancies including the current one
T: number of term gestations delivered (38-42) weeks
P: number of preterm deliveries >20 weeks to 37 weeks, 6 days.
A: number of pregnancies ending before 20 weeks
L: number of currently living children

Question 11

Complications for the first trimester?

Answer 11

Bleeding, signs of infection, vomiting, low abdominal pain

Question 12

Complications during the second trimester?

Answer 12

Regular contractions, leaking vaginal fluid, calf pain, decreased fetal movement

Question 13

Complications during the third trimester?

Answer 13

Anything for the 1st and 2nd. Sudden weight gain, periorbital edema, severe upper gastric pain, headaches with visual disturbances, decreased fetal movement

Question 14

When is chorionic villus sampling done? Explain?

Answer 14

10-13 weeks. Sample taken from the chorionic villi for the placenta. This tissue shares DNA with the fetus.

Question 15

When is MSAFP (alpha-fetoprotein) done? Explain?

Answer 15

16-18 weeks. Blood sample to evaluate the plasma protein produced by the fetal liver and GI system. Crosses from the amniotic fluid to the mother’s blood.

Question 16

Triple and quad screens?

Answer 16

Triple includes: AFP, Estriol, beta hCG. Quad added inhibit A to the triple screen. Low inhibit A increases identification of Down’s syndrome is less than or equal to 35 years of age.

Question 17

Who should be quad tested?

Answer 17

Offered to all pregnant women but especially women with a history of birth defects, of advanced maternal age, who have meds/drugs while pregnant, who have diabetes. Abnormal HCG, low estriol, and low AFP mean possible chromosomal abnormality.

Question 18

What occurs during an amniocentesis?

Answer 18

Amniotic fluid aspirated from the amniotic sac to perform chromosomal analysis, DNA, AFP, inborn errors of metabolism. Can be done any trimester. Risk of possible maternal and fetal blood leakage.

Question 19

What things are amniocentesis best for?

Answer 19

1st for genetic abnormalities. 2nd most common for diagnoses. 3rd for evaluation of fetal lung maturity.

Question 20

Indirect measure of utero-placental function. Done twice weekly for high risk pregnancies.

Answer 20

Fetal well-being non-stress test. Done for 20-40 minutes. Reactive if the fetus accelerates its HR for 15 ppm above the baseline for 15 seconds in a 20 minute period. Non-reactive is the fetus does not meet this criteria.

Question 21

What does a non-reactive fetal well-being non-stress test correlate with?

Answer 21

Fetal distress in labor, fetal mortality, and intrauterine growth restriction (IUGR).

Question 22

Scoring for a fetal well-being biophysical profile?

Answer 22

Movement, tone, breathing, amniotic fluid volume. 2 points for each with a total of 8. Also 2 points if NST is done is reactive, but not always done at the same time as a non-stress test.

Question 23

What immunizations are contraindicated during pregnancy?

Answer 23

Measles, mumps, rubella (MMR). Influenza (nasal). Varicella, BCG, certain strains of the meningococcal vaccine, typhoid.