Pregnancy Care Fundamentals Flashcards
Presumptive signs of pregnancy
- Presumptive signs are the changes that are experienced by the client
- Amenorrhea; absence of a period
- Fatigue
- Breast changes; caused by a wide range of factors; not necessarily pregnancy
- Nausea and/or vomiting
Probable signs of pregnancy
- Probable signs are changes observed by the examiner
- Positive Goodell’s sign; is a softening of the cervix
- Positive beta hCG; the first biomarker of pregnancy; once the ovum is fertilized, the corpus luteum that is left behind releases this. What pregnancy tests looks for as well as blood tests
- But there are other factors that can causes a positive hCG test; confirm levels by blood
- Braxton-Hicks; are uterine tone
Positive signs of pregnancy
- Positive signs are the only signs that indicate fetal presence
- Fetal heart tones
- Visualization of the fetus
- Palpation of fetal movement
Nagele’s Rule for EDB
- EDB = estimated date of birth/when the baby is due
- Nagele’s rule: based on very specific assumptions. Assumes the person has had a regular period every 28 days
- LMP = last menstrual period
- First day of LMP, add 7 days and count forward 9 months
- OR first day of LMP, subtract 3 months, add 7 days plus 1 year
Obstetrical Wheel
• Obstetrical wheel: tool used, and always double check and used on practice
Timing of ultrasounds to EBD
- The first ultrasound (T1; 8-10 weeks) is used for dating accuracy; growth is more predictable. Date is adjusted according to T1
- Important to have fine-tuned EDB; all future decisions are made based on the day
- T2 ultrasound is usually done 18-20 weeks
RN role antenatal
- Assessing coping and adaptations
- Informational support
- Active listening, validation, reassurance
- Data collection
- Anticipatory guidance
- Interprofessional collaboration
- Documentation
Parental developmental tasks antenatal
- Accepting the pregnancy
- Identifying with role of mother/father/parent
- Re-ordering personal relationships
- Establishing a relationship with the fetus
- Preparing for childbirth
ABO incompatibility
- If mother’s blood type is O and baby’s is A or B
- Mother’s plasma can make antibodies that can attack the baby’s RBCs
- Can cause jaundice in baby
Rh+ status
- Rh- don’t have antigens on them, Rh+ do
- Rh- will recognize the Rh+ and start creating antibodies; will affect next pregnancies if Rh+ because sensitization will have occurred and will attack fetus
- Rogam at 26-28 weeks to all clients who are Rh-; if later if mom is Rh- and baby is Rh+, rogam given again postpartum within 72 hours to the adult to reduce immune response so they don’t start that sensitized process
Prenatal care goals
- Promote client, fetal, family health and well-being
- Monitor client-fetal health status
- Identify and minimize risk factors
- Provide appropriate and holistic education and support
- Referral to community resources
- Empowering people to make informed decisions for themselves
Importance of prenatal care
- Determining how to enter the health care system can be challenging for primips; many factors to weigh
- Late entry/no prenatal care has poorer outcomes for client and baby
- Client education is the key to healthy lifestyle choices and practices
Pre-conceptions and prenatal health promotion key components
- Health diet (which includes folic acid ~1mth post conception)
- Exercise and rest
- Optimum weight
- Supporting relationships (fetus, partner, family)
- Use of risk reducing health and sexual practices; smoking, alcohol consumption, prescription medication use, workplace/environmental hazards
Frequency of prenatal visits
- 1st trimester (up to 13 weeks); initial visit then monthly
- 2nd trimester (14026 weeks); monthly
- 3rd trimester (27-term); q2weeks until week 36, q1week until birth
Context of prenatal visits
• Medical and OBGYN history • Social and family history • Physical assessment • Fetal assessment • Diagnostics: - Initial screen - Biophysical testing - Biochemical testing • Health education and promotion; illness prevention • Do's and Don'ts and Red Flags
Focused assessment of prenatal visits
- Subjective (interview/history)
- Weight
- Vital signs (monitor BP especially)
- Urinanalysis (as needed)
- Fundal height
- Fetal movement
- FHR (fetal heart rate) auscultation
Anetnatal and BP
- 140/90 is the first cut off for concerning BP
- Don’t have to have a high BP for the preeclampsia process to start
- Protein in the urine is a sign of preeclampsia; reason for urine tests
Fundal height measurement
- Fundal height measurement
- Bottom of tape at pubis synthesis
- Then to top of the fundus
- 20cm = 19/20 weeks gestation; a gross measurement
Pregnancy Do’s
- Healthy diet with adequate hydration
- Folic acid and PNVs
- Adequate rest and sleep
- Physical activity
- Flu shot, Tdap
Pregnancy Don’ts
• Foods to avoid: - Raw meats - Fish • Smoking, alcohol abuse (no safe level) • Substance abuse • Hot tub/sauna • Avoid risky behaviour • Avoid cat litter
Pregnancy Red Flags
- Vaginal bleeding
- Vaginal discharge (leaking)
- Contractions
- Pain (abdominal, back, urination, epigastric)
- Decreased fetal movement
- SOB, chest pain
- Fever
- Severe headache
- Visual disturbances (blurry, spots, diplopia)
- Accidents/falls/injuries
- Any other concerns
Ontario Prenatal Record (OPR)
- Taken for all clients in province who are pregnant
* All information can be found there
Prenatal Community Resources
Examples: • Toronto Public Health • Health Babies Healthy Children • Homeless At Risk Prenatal Program (HARP) • Canada Prenatal Nutrition Program • Community Health Centres • Prenatal classes
Role of Human chorionic gonadotropin during pregnancy
- Source; Fertilized ovum and chorionic villi
* Maintains corpus luteum production of estrogen and progesterone until placenta takes over the function
Role of Progesterone during pregnancy
- Source; corpus luteum until 14 weeks of gestation, then the placenta
- Suppresses secretion of FSH and LH by the anterior pituitary
- Maintains pregnancy by relaxing smooth muscles, decreasing uterine contractility
- Causes fat to deposit in subcutaneous tissues over the maternal abdomen, back, and upper thighs
- Decreases mother’s ability to use insulin
Role of estrogen during pregnancy
- Source; corpus luteum until 14 weeks gestation, then the placenta
- Suppresses secretion of FSH and LH by the anterior pituitary
- Causes fat to deposit in subcutaneous tissue over the maternal abdomen, back and upper thighs
- Promotes enlargement of genitals, uterus, and breasts
- Increases vascularity
- Relaxes pelvic ligaments and joints
- Interferes with folic acid metabolism
- Increases the level of total body proteins
- Promotes retention of sodium and water
- Decreases secretion of hydrochloric acid and pepsin
- Decreases mother’s ability to use insulin
Role of oxytocin during pregnancy
- Source; posterior pituitary
- Stimulates uterine contractions
- Simulates milk ejection from breasts
Role of prolactin during pregnancy
- Source; posterior pituitary
* Prepares breasts for lactation
Hemoglobin, hematocrit/WBC, differential
Lab test in prenatal period
- Detects anemia
* Detects infection
Hemoglobin electrophoresis
Lab test in prenatal period
• Identifies women with gemoglobinopathies (e.g. sickle cell anemia, beta-thalassemia)
Blood type, Rh, and presence of antibodies
Lab test in prenatal period
• Identifies fetuses at risk for developing erythroblastosis fetalis or hyperbilirubinemia in neonatal period
Rubella, varicella and parvovirus B19 titre
Lab test in prenatal period
• Determined immunity to rubella chicken pox, and parvovirus (particuarlly in woman with previous child or exposure to children in workplace)
TB skin testing (depending on history); chest film after 20 weeks gestation in woman with reactive TB test
Lab test in prenatal period
• Screens for exposure to TB
Urinalysis; including microscopic examination of urinary sediment, pH, specific gravity, colour, glucose, albumin, proteins, RBCs, WBCs, casts, acetone, hCG
Lab test in prenatal period
- Identifies women with unsuspected diabetes mellitus, renal disease, hypertensive disease of pregnancy
- Infection
- Occult hematuria
Urine culture
Lab test during pregnancy
• Identifies women with asymptomatic bacteriuria
Renal function tests: BUN, creatinine, electrolytes, creatinine clearance, total protein excretion
Lab test in prenatal period
• Evaluates level of possible renal compromise in women with a history of diabetes, hypertension or renal disease
Papanicolaou test
Lab test in prenatal period
• Screens for cerical intraepithelial neoplasma. herpes simplex type 2, and HPV
Vaginal or rectal smear for Neisseria gonorrhoea, Chlamydia, HPV, and GBS
Lab test in prenatal period
- Screens high-risk population for asymptomatic infection
* GBS screening recommended at 35-37 weeks for all women
RPD/VDRL/FTA-ABS
Lab test in prenatal period
• Identifies women with untreated syphilis
HIV antibody, hepatitis B surface antigen, toxoplasmosis
Lab test in prenatal period
• Screens for the specific infections
1hr glucose tolerance
Lab test in prenatal period
- Screens for gestational diabetes
- Done at initial visit for woman with risk factors
- Recommended to be done at 28 weeks for all pregnant woman (earlier if risk factors)
2hr glucose tolerance
Lab test in prenatal period
- Screens for diabetes in women with elevated glucose level after 1hr test
- Must have 2 elevated readings for diagnosis
Cardiac evaluation: ECG, chest x-ray, echocardiogram
Lab test in prenatal period
• Evaluates cardiac function in women with s history of hypertension or cardiac disease
