prenatal Flashcards
prenatal care goals: 1st trimester
- screen for maternal risk, problems(ectopic pregnancy, htn, comorbid disorders)- screen for fetal genetic abnormalities- prevent fetal phenotype abnormalities
prenatal care goals: 2nd trimester
“golden trimester” - LOTS of teaching- ultrasound- screen for fetal phenotype abnormalities- continued monitoring mom/fetus
prenatal care goals: 3rd trimester
- monitor for gestational hypertension (major mom morbidity)- prevent preterm birth (major neonatal morb/mortality)- monitor fetal health
ectopic pregnancy
fertilized ovum implants outside of uterine cavity: abdomen, uterine tubes, and ovariessignificantly increased in last 30 years due to chlamydia, gonnorhea scarring tubes
traditional visit schedule
outdated.q4 weeks until 28q2 until 36q week
centering pregnancy
superior prevention of preterm birth- individual care until 15 weeks- 15-36: group of 8 to 12 women - q4 until 3rd trimester; then q22 hour visits, lots of dialogues, belly checks
fetal testing during pregnancy should be offered to…
ALL WOMEN UNIVERSALLY REGARDLESS OF AGE
majority of babies with trisomy 21
in moms
dental problem significance
consistent with preterm birth - gum infection inflammatory response can spread through bloodstream
progesterone during pregnancy effect
slows down gastrointestinal system = constipation
systolic murmur in pregnant women significance
okay, especially past 20 weeks - she has an extra liter of blood circulating
physiologic hydronephrosis
ureters very dilated, easier for germs to mve from bladder up to kidney - urine culture!
ultrasound uses
dating, viability, rule out ectopic pregnancyaccurate within 1 week, prefer over naegele
hcg significance
fetal viability - large amounts cease period. corpus luteum creates progesterone 8-12 weeks then disintegrates, when placenta takes over. once baby’s heart starts beating –> ultrasound time
ectopic pregnancy s/s
pain (spontaneous, adnexa)slowly rising hcgsometimes bleedingcan cause death: can rupture major vessels leading to severe bleeding
naegle’s rule
1st day of LMP - 3 months + 7 daysLMP + 7 days + 9 months
fundal height changes
1cm per week 18-36
fetal heart tones heard
12 weeks (doppler)20 (fetoscope)
urine testing nota bene
no longer routine for healthy women
warning signs: 1st trimester
extreme pain (ectopic!)bleeding (more than spotting)can’t hold down liquids/solids for SEVERAL hoursillness (UTI, swelling of one calf)
warning signs: 2nd trimester
bleedingcessation of fetal movement after quickeningany major illnesses
warning signs: 3rd trimester
bleedingdecreased fetal movement (10x 12 hours)severe abdominal painrupture of membranesptl symptoms (contractions > 5 per hour, backache, pelvic pressure)gestational hypertension signs
fetal testing: 1st trimester
goals: chromosomal abnormalities. catch early = options!- fetal cells in maternal blood- chorionic villus testing (risk of miscarriage)- nuchal fold skin testing
fetal testing: 2nd trimester
phenotype testing:- maternal serum alpha-fetoprotein/quad screen (open neural tube defects)- trisomy 21, 13chromosomal testing:- amniocentesis (diagnosis, not screening - high risk for miscarriage)
fetal testing: 3rd trimester
goal: fetal wellbeing. it’s viable!diabetes @ 28 weeksGBS @ 35-37repeat GC/CT/STIs if at risk
Rh+ fetus immune response (2 stages)
1st: IgM (acute infection, doesn’t cross placenta)2nd: IgG (memory; crosses placenta)
weight gain: underweight
28 - 40 lbs
weight gain: normal
25 - 35 lbs
weight gain: overweight
25 - 42 lbs
folic acid significance
decrease in neural tube defects
not breastfeeding weight loss recommendation
500 cal decrease + healthy diet
listeria significance
listeriosis is bad for baby, crosses placenta and causes major problems.in: deli-style meats, unpasteurized soft cheese, high-mercury fish
psychological adjustment: 1st trimester
ambivalence normal
psychological adjustment: 2nd trimester
attachment
psychological adjustment: 3rd trimester
mothering role
