OB Module 2: Antepartum Nursing Flashcards
Where is the female bladder located
anterior to the uterus and vaginal vault
The uterus leans ___ on top of the ____
forward on top of the bladder
In post partum, a distended bladder can do what?
displace the uterus and make it hared to stop a hemorrhage
Where is the female rectum located?
Immediately behind the uterus and vaginal vault
Retroverted
position of the uterus where the base of the uterus softens and can lean back toward the rectum rather than forward
this can affect when we hear Fetal heart beat or symptoms of pregnancy
Anteverted
position of the uterus where it tips forward from the cervix toward the abdomen
Fimbriae
capture the egg and have motion to move the egg along the tubes (on the side) to get it into the uterus
During ovulation, the ovum leaves where and enter where?
leaves the ovary and enters the fallopian tube
Fertilization generally occurs where
in the outer third of the fallopian tube
When does cell division of the ovum start>
Cell division starts as the ovum advances through the fallopian tube to the uterus where it will implant in the uterine wall lining
Ovulation
time each month that several eggs will move toward development with one usually being the one to become fully developed
Corpus Luteum
Once an egg is released, its ovary sac will become the corpus luteum
This will produce hormones until the placenta implants and can do it on its own
Pregnancy and Antepartum Care involves what things?
Diagnosis of the pregnancy
Signs and symptoms
General body system changes
Adaptation to pregnancy
Prenatal Care
Factors which influence pregnancy outcomes
Human pregnancy is designed to last for ___ weeks of “gestation.” Including the __ weeks before conception (when the last menstruation and ovulation were)
40 weeks; 2 weeks
(so that is 38 weeks of dev)
Pregnancy is described in terms of ___
trimesters
Are trimesters equal in length?
No - it is a 40 week period that does not split evenly
1st Trimester
1-12 Weeks
2nd Trimester
13-27 Weeks
3rd Trimester
28-40 Weeks
The major infant organs are formed by …
8 weeks (but that doesnt mean they are fully functional at 8 weeks)
Although the organs are formed, many essential systems are only …
minimally functional by week 24
After organ formation at 8 weeks, the rest of the pregnancy focuses on …
further development, growth, and maturation
Micro Preemies
Infants born between 23-27 weeks
Require considerable supportive care (their organs still needed more development time for example)
If they survive in the ICU nursery, they will have some disability in the end
Diagnosis of a Pregnancy Involves what kinds of signs
Presumptive Signs
Probable signs
Positive signs
What are Presumptive Signs of Pregnancy?
Signs the mother can perceive (subjective) that are not definitive since there are other illnesses that can mimic these symptoms
List the Presumptive signs of pregnancy
cessation of menses
N/V
Breast changes - enlargement and tenderness
Urinary frequency
fatigue
elevation of basal body temp
leakage of colostrum
excessive salivation at 4-14 weeks
quickening
Quickening
The mothers perception of fetal movement
18-20 weeks primips (first time mom)
16+ weeks multips (woman whose had babies before)_
What are probable signs of pregnancy
signs that are more objective and seen by the physician, increasing the likelihood of pregnancy, but they cannot be used to make a definitive diagnosis as other things could cause this
List the probable signs of pregnancy
Chadwick’s Sign
Hagar’s Sign
Piskacek’s Sign
McDonalds Sign
Goodells Sign
Abdomen enlargement
Uterine Soufflé
Palpation of fetal outline
Ballottement
Fetal movement witnessed
Positive pregnancy test
Skin color changes like appearance of Montgomery’s tubercles
Chadwick’s Sign
Blue or purple discoloration of the vulva and vaginal mucosae, including the vaginal portion of the cervix
begins around 8 weeks and beyond
Hegar’s Sign
The softening and compressibility of the uterine isthmus
Because of this softening the uterus may be anteflexed or retroverted
occurs at 6-12 weeks
Piskacek’s Sign
Asymmetry of the uterus with a rough, irregular contour on one side
The side that is rough is the side the placenta implanted on
Occurs at week 4-5
McDonald’s Sign
an ease in flexing the body of the uterus against the cervix
Goodell’s Sign
the softening of the cervix around 5 weeks
(after some time it will harden again to not give way)
Isthmus
area between the cervix and the upper body of the uterus
(lower uterus)
Why do McDonald’s Sign and Hegar’s Sign go together?
Because the isthmus softens so the heavier upper body of the uterus can press against the uterus
Mucus Plug
a product of the cervix made to prevent anything getting through the vaginal vault and impacting the pregnancy
Uterine Souffle
Blowing sound of increased blood flow around the uterine area
This occurs from the high pressure and increased vascularization
Montgomery’s Tubercles
small bumps emerging on the areola that secrete lubricant for the nipple
What are positive signs of pregnancy
signs that confirm a pregnancy
List the Positive signs of pregnancy
- Auscultation of fetal heart tones (10-12 weeks)
- Fetal movement perceived by the provider
- Visualization of the fetus through ultrasound or X ray
When can the fetal heart tones first be heard?
around 10-12 weeks
What can an ultrasound image confirm at 4-5 weeks and at 6 weeks?
4-5: Sac
6: Fetal Pole
We do not do what unnecessarily if we suspect a pregnancy?
Give an X Ray
Sometimes coincidentally we find out though when they are getting an X ray for something else
Pregnancy testing is done to assess levels of ___ produced by the fetus in either ___ or ___ serum to determine the presence of a viable pregnancy
hCG (human chorionic gonadotropin); urine; blood
What is the easiest to administer and least expensive method clinical pregnancy test?
Urine Based hCG test
When is a urine based hCG test done during the day, and when is the first time period it is accurate?
First morning voiding
10-14 days after the first missed menses
What can Serum hCG (blood) testing do that a Urine based test cannot?
- It is not dependent on time of day
- can detect a pregnancy earlier
- serial testing can also be used to assess the potential viability of a pregnancy
Ways to Date a Pregnancy
Naegele’s Rule
Uterine Sizing
Ultrasound
Naegele’s Rule
Dating a pregnancy based on the rule that the 1st day of the last menstrual cycle + 7 days and then - 3 months gives an estimated date of delivery
Uterine Sizing is a way to date a pregnancy, what is the size of the uterus at 8, 10, and 12 weeks?
8 - egg sized
10 - orange sized
12 - grapefruit and at the pelvic brim
At week 12, the uterus is grapefruit sized and now located at the pelvic brim so what can we do now?
Do an ultrasound to hear fetal heart tones
If we know the size of the uterus at week 12, but cannot hear heart tones…
we should be concerned about pregnancy’s viability
The earlier the ultrasound…
the more valid dating it gives and the more accurate it is
Why are ultrasounds less accurate later on?
After periods like 20 weeks of gestation, other factors begin to effect size
What does GPTPAL stand for when documenting a pregnancy
Gravida
Parity
Term
Preterm
Abortions
Living
Its either written as something like G7P6 or G7T4P2A0L6
(GPTPAL) Gravida
any pregnancy regardless of gestation including the current pregnancy (miscarriage, abortion, live, etc)
(GPTPAL) Parity
any birth after 20 weeks gestation whether born alive or dead
(GPTPAL) Term
number of infants born at or after 38 weeks gestation
(GPTPAL) Preterm
Number of infants born between 20 weeks and 38 weeks
(GPTPAL) Abortions
number of infants born before 20 weeks gestation whether born alive or dead
(GPTPAL) Living
number of children alive currently
Why did we switch from just using Gravida and Parity to a system where were use Gravida, Term, Preterm, Abortions, and Living?
GP did not give us a good feel for those who had pre term babies and who may not be having babies that survive or life, so we had a system where we added TAL and replaced Parity with preterm
Nulligravida
Woman who has never been pregnant
Primigravida
Woman pregnant for the first time
Multipara
woman who has had two or more births at more than 20 week’s gestation
Multigravida
Woman in second or any subsequent pregnancy
also called Multips
Normal gestation is __ weeks
40
Where does the placenta usually implant?
Near the fundus (top of the uterus)
The uterus is mostly ___
muscle
As the pregnancy occurs, the uterus gets more __ and ___
distended and thicker
How are babies typically positioned in the womb near term and before 37 weeks?
They are generally head down toward the cervix near term. but before 37 weeks they are small in a large pool of fluid and may change position frequently
Uterus
usually pale pink organ that turns burgundy from vascularization during pregnancy
Comprised of muscle and increased in size and thickness of muscle mass during pregnancy
made up of the corpus (body), isthmus (center), fundus (top), cervix (bottom)
Placenta
a disk shaped organ which starts to form at implantation
Has multiple functions
What functions does the placenta have?
- Supplying fetus with o2 and nutrients
- removing CO2 and waste materials
- producing hormones to maintain the pregnancy
- producing amniotic fluid
Based on current research as of April 2021, can COVID-19 infect a baby in the womb?
no it cannot cross the placenta or go into breast milk
Do the mother and fetal blood intermix in the placenta?
No
Fetal and Mother blood are separated by …
the placental membrane which helps to protect the fetus from many environmental factors
Some molecules are small enough to cross the placental membrane and affect the pregnancy, what are some examples?
Alcohol
Some Viruses
Toxic Chemicals
How do the fetal side and maternal side of the placenta differ?
Maternal Side - looks meaty and coalesced (ridges with depressions in it)
Fetal Side - shiny with membranes coming off of it to make the amniotic sac. Fetal blood vessels come centrally into the umbilical cord to provide things
Chorion
outer level of the amniotic sac
Amnion
inner level of the amniotic sac
Amniotic Sack
a fluid filled double layer pouch which surrounds the fetus providing a protective barrier for the infant
Also allows the lungs to develop since they do not need to push off the uterine wall
Can also maintain the uterus as a dilated vessel that the infant can easily practice moving in
Fluid is made by the placenta
Human Chorionic Gonadotropin (hCG)
The first placental hormone produced is hCG
Can be found in maternal blood and urine as early as the first missed menstrual period and up through the 100th day of pregnancy
This is the hormone analyzed by a pregnancy test
Present only during pregnancy since it is secreted by the placenta
hCG is not used after __ months as an indicator
3
Progesterone
the most significant hormone for maintaining pregnancy
It is needed to maintain the endometrial lining of the uterus during pregnancy
Levels are high during pregnancy and is made by the placenta
Sometimes given supplementally if pregnancy at risk
Prevents preterm labor by reducing myometrial contraction
Estrogen
stimulates the development of secondary female sex characteristics usually
In pregnancy, it helps the woman’s mammary gland development in prep for lactation and stimulates uterine growth to accommodate the growing fetus
Relaxin
hormone made by corpus luteum
during first trimester levels rise and additional amounts are made by the decidua (placenta)
peaks during the 14 weeks of the first trimester and at delivery
mediates the hemodynamic changes of pregnancy such as increased CO, renal blood flow, and arterial compliance
Relaxes other pelvic ligaments and softens the pubic symphysis
Circulating volume in pregnancy increases __-__%
30-50%
Human Placental Lactogen (hPL [Human Chorionic Somatomammotropin])
Lactogenic and growth promoting property hormone
promotes mammary gland growth in preparation for lactation
Also regulates maternal glucose, protein, and fat levels so that this is always available to the ftus
Why does a pregnant woman tend to waddle?
Relaxin makes the pelvic muscles less stable to allow labor and delivery later
Cardiovascular Changes in Pregnancy
Slight Cardiac Hypertrophy (to make up for increased volume)
Upward cardiac displacement (baby pushes diaphragm up)
Increased blood volume, cardiac output, pulse rate, and tendency toward arrhythmias
Relaxation of vascular bed tone to accommodate volume
How many BPM can a pregnant woman increase in during pregnancy?
10-15 BPM
Respiratory changes in pregnancy
O2 requirements increase
Increased chest expansion
Lower rib cage flares out
Upward displacement of diaphragm
upper resp tract more vascular and therefore is more congested (can cause snoring)
Increased tidal volume and capacity, but decreased reserve and residual volumes
What does “increased tidal volume and capacity, but decreased reserve and residual volumes” mean?
There is increased capacity, but when resting/emptying there is lower reserve and residual air in the lungs leftover
Renal Changes in pregnancy
renal pelves and ureters dilate
uterus enlargement puts pressure on bladder and ureters
urinary flow rate slower
UTIs common
glomerular filtration increased
renal blood flow increases
increased renal function in the lateral position (important to diuresing)
decreased BUN and Creatinine
glucose present in urine normally
Integumentary changes in pregnancy
increased skin thickness, subdermal fat, hair and nail growth, sweat and sebaceous gland activity, circulation and vasomotor activity
Hyperpigmentation
cutaneous elastic tissues are more fragile resulting in increased tendency for stretch marks (when we need it more elastic, it is becoming more fragile!)
What are some common skin findings in pregnant women?
Dependent Edema
Melasma
Spider Nevi
Striae gravidarum
Linea Nigra
___ edema in pregnancy is not uncommon, but ___ edema is indicative of disease
dependent; generalized
Linea Nigra
A large vertical dark line that can form down the pregnant woman’s stomach
Melasma
darkening in areas like the face (sort of in a butterfly shape)
Spider Nevi
tiny spider like veins and red spots of vascularization appearing on the skin
Striae gravidarum
stretch marks
pink to silver in color over time
Neuromuscular system changes in pregnancy
center of gravity shifts
lordosis develops
relaxation and softening of connective tissues occur
abdominal muscles weaken and separate
increased tendencies toward HA, syncope, muscle cramping and numbness
Why is syncope very common early in pregnancy?
Because of the relaxation of the vasculature without the accompanying increased circulatory volume yet
GI changes in pregnancy
appetite fluctuates (diminishes early on)
intestinal secretions decrease while absorption of nutrients increase
tendency toward nausea early on
colon is displaced
decreased gastric motility
food cravings and changes in food taste (can be temp or permanent)
increased salivations
What is causing the increase in absorption of nutrients, decrease in intestinal secretions, and decreased gastric motility in pregnancy?
Progesterone
it is to allow there to be more time to allow for absorption
Calorie increase of ___ calories will begin in pregnancy over a pre pregnant diet
(only) 200 calories
this isn’t a large jump, but this needs to be a nutrient rich 200 calories
What should be done with a pregnant woman at risk in order to assess diet practices and allow for adjustments early in pregnancy?
a 24 hour recall dietary assessment
assesses for malnutrition and issues with nutrition, but has the problem of not representing normal patterns
Pica
An issue that can occur in pregnancy where there is unusual non nutritive food cravings
these practices can lower a womans consumption of nutrient rich foods
ex: commonly ice eating, soap powder, dirt cravings, weird stuff
What should a diet look like in a pregnant woman?
- 4 or more servings of fruit/vegi
- 4 or more servings of whole wheat or enriched breads/cereals
- 4 or more servings of milk products
- 3 or more servings of protein
- Folic acid - 400 mcg in diet or supplement (Folic Four)
- Calcium 1200-1500 mg
A woman of average weight before pregnancy should gain __ to __ pounds during pregnancy
25-35 pounds
An underweight woman before pregnancy should gain __ to __ pounds during pregnancy
28-40 pounds
An overweight woman before pregnancy should gain __ to __ pounds during pregnancy
15-25 only
If a woman is expecting twins she should gain __ to __ pounds during pregnancy
35-45
What things contribute to the weight gain of a pregnant woman?
1 is the fetus, #2 is the increase in blood
We then have the uterus and breast, other tissue like fat, ECF, amniotic fluid, and the placentae
Who are some populations at risk nutritionally during pregnancy?
Adolescents
Those having frequent pregnancy’s like 3 in 2 years time
Prior poor fetal outcome
Poverty
Poor diet habits with resistance to change
Use of tobacco, alcohol, or drugs
Multifetal pregnancies
Anyone underweight or overweight at conception
Anyone with problems with weight gain or weight loss
History of eating disorders
Low H&H
Pregnancy is a major __ milestone
maturational
What sort of developmental tasks must a pregnant woman master?
Accepting the pregnancy
Identifying with the role of mother
Reordering the relationship with her mother and her partner
establishing a relationship with her unborn child
Preparing for the birth experience
It is not uncommon to be ___ in the first trimester
Ambivalent
The relationship with the unborn child increases a lot in the first trimester after….
there is awareness by the mother of movement
What are the 3 major factors influencing adaptation to a pregnancy?
- Maturation Level
- Supportive relationship with mother
- Supportive relationship with partner
can they make someone else a priority over them?
In the second trimester, adaptive changes include what things and what developmental tasks?
Shifting focus from self to fetus
Developing a relationship with the fetus
Accepting the pregnancy and her changing body image
Initiating preparations for the arrival of the infant
Starting childbirth preparation classes
relative ambivalence now shifts to accepting pregnancy changes
What trimester is the optimal time to start childbirth prep classes and why?
Second Trimester
This is because some pregnancies are preterm and some do not get to the third trimester, so it is important that they know the exercise and knowledge just in case
Education in the second trimester should include information about what things?
nutrition and weight gain
exercise and safety
warning signs of complications
avoiding substances harmful to the pregnancy
common discomforts in pregnancy
prenatal education classes should be started late in 2nd tri
Adaptive changes in the 3rd trimester include…
ongoing education and prep for labor
creating a labor plan
negotiating labor support personnel
continuing preparations for the arrival of the infant
continuing to develop a relationship with her unborn child
What is important to consider when making the labor plan?
Know what to expect at birth, but do not put extreme expectations and be inflexible
Never having done labor makes it harder to anticipate
Also, the length of a labor plan correlates to C Section needs
Labile Emotional States & Pregnancy
Rapid mood change from hormones surging
First trimester involves ambivalence but the second trimester involves more general feelings of well being
Rubin’s Four Developmental Tasks of Pregnancy
- Ensuring safe passage through pregnancy, labor, and birth
- Seeking acceptance of the child by others
- Seeking commitment and acceptance of herself as a mother to the infant
- Learning to give oneself on behalf of one’s child
When reordering relationship with partner, what 2 things does the pregnant woman need
- To feel loved and valued
- For the partner to accept the pregnancy
When reordering relationship with mother, what 3 things does the pregnant woman need?
- Acceptance of the pregnancy
- Emotional Support
- Guidance regarding pregnancy, labor, and mothering
If mother or partner are not present or supportive…
the woman will seek support and guidance from other sources
What are the important components of prenatal care in the 1st trimester
Early assessment and intervention if needed
Early and accurate dating of the pregnancy
Education regarding behaviors which enhance successful pregnancy
Counseling regarding risk behaviors
Prenatal care allows for these things
Assessments during the 1st trimester include
making a data base and assessing risk factors
physical examination
lab tests
The interview is a major component of initial prenatal care and factors identified there…
can help to frame the care for the rest of the pregnancy
What is important to do during the initial prenatal interview?
Give adequate time and a private environment
Since woman come from a wide variety of social backgrounds and situations, stay non judgmental in assessment
A woman who feels accepted is more likely to be open and honest in disclosures
The initial prenatal interview contains…
demographic information
current pregnancy history
OB and gyno history
current and PMH
nutritional history
substance use history
family hx
psychosocial and experiential history including abuse
ROS
What laboratory tests may be done in the first prenatal visit?
CBC
Blood type and Rh
Antibody Screen
rubella titer
urinalysis
RPR/VDRL
HIV testing
Glucose
TORCH studies (toxoplasmosis, other infections, rubella, cytomegalovirus, herpes simplex virus)
How does Rh incompatibility develop
If the mom is rh- and the baby is rh + this will not impact the first pregnancy, since no blood mingled with the placental barrier in place – however the blood mingles during delivery
So, the mother will make antibodies against the rh+ blood and these antibodies can get across the placental barrier and impact future pregnancies
Need to give Rhogam to prevent this around28 weeks gestation through 12 weeks until delivery when mini placental separations can occur
What sort of Cervical Cultures need to be done in initial prenatal visits?
Cultures for Gonorrhea and Chlamydia
pap smear
other testing based on findings such as tuberculin tests, cystic fibrosis tests, genetic tests, ultrasounds
The initial prenatal visit physical exam includes what things?
VS and BP
Urinalysis
Height and Weight
Full systems exam
Nutritional exam
Breast exam
Bimanual exam
Pap smear and culture taking
Assessment of uterine size
Assessment of fetal heart tones (week 10+)
Teaching in the first prenatal visit should include information on…
S/S of complications
smoking cessation and substance avoidance
infectious avoidance - such as toxoplasmosis in cat feces
nutrition
exercise, posture, and body mechanics
fetal growth and development
relationship changes
future testing
care during pregnancy including dental care
reliable information resources (up to date and not just wrong online sources)
After 12 weeks gestation, the uterus does what?
the uterus becomes large enough to rise out of the pelvis and into the abdominal cavity. The abdomen will show signs of enlarging
At around 5 months, the breasts start to form…
colostrum
The uterus (top) tends to start rising from __ weeks and beyond and will correlate from distance between anterior pubic bone’s top to the top of the top of the uterus in ___ of height
20 weeks
centimeters
Around 28 weeks there is __ cm between anterior pubic bone and uterus; at 30 weeks it is __ cm
28;30
When will the uterus start to drop a bit
at 38 weeks it will begin to fall rather than rise
Engagement
point at which the baby drops back into the pelvis (38 weeks)
When does engagement occur?
in the first pregnancy it starts around week 38, but in future pregnancies it starts at onset of labor
During the 2nd trimester, increasing blood volume causes congestion in many tissues, what may happen as a result?
the woman may still be experiencing fatigue if her body is not keeping pace with creating red blood cells to fill the expanding blood volume
This is physiologic anemia and may need iron supplementation
When should prenatal visits be scheduled?
Every 4 weeks for the first 28 weeks, every 2 weeks until 36 weeks gestation, and every 1 week until birth after 36 weeks
This changes though if complications arise or there are additional risk factors then making visits more often
Prenatal care in the second and third trimesters involve what?
routine assessments such as:
urinalysis
weight
BP
fundal height assessment
fetal heart rate assessment
Why do we do urinalysis in the 2nd and 3rd trimesters?
To check for proteins and ketones
Ketones can signify nutritional issues/muscle breakdown
Proteins can signify preeclampsia
How does the physician measure fundal height ?
Measures with a tape measurement from the anterior pubic bone to the top of the uterus
Testing in the 2nd trimester include…
Maternal serum alpha fetal protein or Quad test
18-20 week ultrasound (2nd tri)
assessment for quickening (earlier in second time moms, later in first time moms)
Quad Test
test screening for down syndrome or open neural tube defects
What is the problem with the 18-20 week ultrasound?
it has a 90% false positive rate - which is significant- and can signify need for amniocentesis which is invasive and has a 1% loss rate
Testing in the third trimester includes…
28 week H&H
1 degree Glucose tolerance test
Mini dose Rhogam (if Rh negative)
Screening for group B strep
additional optional testing like a nonstress test, stress test, ultrasound, BPP
Why is the pregnant woman at a predisposition for gestational diabetes
because there is a strain on adequate nutritional processes
Why is a Group B strep screen done at 36 weeks?
While it is normal vaginal flora in 25% of women and not an issue until labor it can cause resp infections in a newborn with 15% dying or having complications
So we do a vaginal swab and if positive we treat AT LABOR to prevent infection (we are not getting rid of it totally though on the mom)
It is NOT an STD
Nonstress test
Period of fetal monitoring in absence of contractions
It can check for appropriate reaction with induced contractions to check
BPP
biophysical profile
a more elaborate ultrasound check for fetal wellbeing indicators
__% of infants born to Strep B positive women will become infected, and there is a __% mortality rate in this group
3;15
The placenta is created to last and supply the infant with O2 and nutrients for __ weeks
40
What may be an issue regarding the placenta in the third trimester?
Some factors can cause premature deterioration resulting in O2 and nutrient decreases such as smoking (and smoking can decrease placental blood flow for up to 2 hours!)
Some pregnancies go beyond 40 weeks and the placenta starts to decrease and deteriorate
Certain tests will check for fetal status or reserve though
What sort of discomforts of pregnancy tend to increase or occur throughout the 2nd and 3rd trimesters>
breast changes and pain
frequency and urgency of urination
fatigue
GI upset
gingivitis
nasal stuffiness
constipation
sleep disturbances
dependent swelling
varicose veins and hemorrhoids
low back pain
carpal tunnel syndrome (from increased interstitial fluid)
What sort of pregnancy comforts occur during the third trimester?
- increased pressure from the enlarging uterus which can cause venous stasis with edema in the legs, varicose veins, and discomfort
- Potential for a vagal response when lying on their back
fetus continues to grow in size and organ systems continue to mature though
Why is a vagal response a potential discomfort that can happen starting at 20 weeks and beyond?
if she lays on her back the heavy uterus lays on the inferior vena cava instigating the response
It will make her feel lightheaded, nauseous, and generally feel bad
You should put her on her side, check her vitals and the heart tones of the baby
During the third trimester of pregnancy, the uterus develops what?
Oxytocin receptor sites
Oxytocin
the love and contraction hormone
involved in the love she has for child and aids in causing contractions in labor and delivery
it does not work earlier in the pregnancy because the uterus has not developed receptors yet
Cervical “Ripening”
the cervix has been hard and unable o give way under the weight of the pregnancy, will begin to soften and take on water to become more elastic in the third trimester to prep for delivery
can palpate and feel the difference
The great stressor in any pregnancy is
labor contractions
Why is it important to do a nonstress test?
allows for monitoring in the absence of labor and therefore a non stress situation - done in third tri
What occurs for normal non stress test results?
a woman is placed on a fetal monitor for at least 15 minutes
To be reactive, there must be 2 accelerations in the fetal heart rate of at least 15 BPM lasting for at least 15 seconds in a 20 minute period
Contraction Stress Test (CST
Test done if the nonstress test raises suspicion about the status of the infant - done in 3rd tri
The woman is on a fetal monitor throughout the test, and contractions are induced to watch infant response
If there is any evidence of fetal intolerance the test is stopped and the infant must be delivered by C Section
BPP
Biophysical profile
a more involved ultrasound assessment which measures for 4 criteria of fetal wellbeing
done in 3rd tri
What are the 4 criteria of fetal wellbeing looked at in a BPP
Amniotic Fluid Level
Fetal Breathing
Fetal Tone
Fetal movement
What is some PRE-conception care that should be done for a mother?
immunization status
underlying med issues
reproductive health care practices
sexuality and sexual practices
nutrition
lifestyle practices
psychosocial issues
medications and drug use
support system
A woman planning a pregnancy should start with ___ mcg of folic acid supplementation ___ before she conceives
400 mcg; daily
