Prenatal Care Flashcards
Initial Prenatal Care
What assessments will be done at first prenatal visit?
Prenatal History
Physical Assessment
Laboratory Testing
Demographic information
Age, educational level
Ethnic background
Socioeconomic status
Details of Current Pregnancy
First day of last normal menstrual period (LMP)
Presence of complications
Attitude toward pregnancy
Results of pregnancy tests, if completed
Presence of discomforts since LMP
Number of pregnancies, number of living children
Number of abortions, spontaneous or elective
History of Previous pregnancies
Length of pregnancy Length of labor and birth Type of birth Type of anesthesia used (if any) Woman’s perception of the experience Complications associated with childbirth Neonatal complications
Basic Screening Tests at initial visit (6)
Pap smear
Gonorrhea and Chlamydia cultures
U/A
Urine C&S
Maternal Serum labs (next slide)
Ultrasound – if warranted by history or physical
Clinical Pelvimetry (5)
Pelvic inlet Diagonal conjugate Measure at least 11.5 cm Obstetric conjugate 10 cm or more
Closed Fist to Measure Outlet
Pelvic outlet
Anteroposterior diameter should be 9.5 to 11.3 cm
Transverse diameter should be 8 to 10 cm
Normal Physiologic Changes during Pregnancy
Vital signs
Temperature, blood pressure unchanged
Pulse may increase by 10 bpm
Respiration may be increased and thoracic breathing predominant
Weight varies: Should be proportional to the gestational age of the fetus
Nose: Nasal stuffiness
Mouth: Gingival hypertrophy, ptyalism
Normal Physiologic Changes during Pregnancy (3)
Neck
Chest and lungs
Breasts
Neck: Slight hyperplasia of thyroid in the third trimester – small, nontender nodes
Chest and lungs: Transverse diameter greater than anterior-posterior diameter
Breasts Increasing size Pigmentation of nipples and areola Tubercles of Montgomery enlarge Colostrum appears in third trimester
Normal Physiologic Changes during Pregnancy (3) 6 Abdomen Pelvic Cervix Uterus
Abdomen
Progressive enlargement
Fetal heart rate heard at approximately 6-8 weeks’ gestation
Pelvic area: Vagina without significant discharge
Cervix closed
Uterus shows progressive growth
Extremities: Possible edema late in pregnancy
Spine: Lumbar spinal curve may be accentuated
Normal Physiologic Changes during Pregnancy
Skin
Lab tests
Skin: Linea nigra Striae gravidarum Melasma Spider nevi Laboratory tests Physiologic anemia may occur (decrease in hemoglobin and hematocrit) Small degree of glycosuria may occur
Return Prenatal visits
Prenatal visits
Every 4 weeks for the first 28 weeks’ gestation
Every 2 weeks from 28 weeks’ until 36 weeks’ gestation
After week 36, every week until childbirth
Every Subsequent Prenatal Visit
Chart review
Interval history – what’s happened since the previous visit
Nutrition follow-up
Psychological stage of pregnancy
Spiritual & Cultural assessment update
Every Subsequent Prenatal Visit
Focused physical assessment Vital signs, especially blood pressure Weight and presence of edema Fundal height - uterine growth Fetal heartbeat Fetal movements and presentation Urinalysis for glucose, albumin, ketones (dipstick)
Pelvic exam or sterile vaginal exam if indicated
Triple and Quadruple
at 14 to 22 weeks gestation (best at 16 -18 weeks)
“Triple Marker” not diagnostic
MSAFP, Quantitative Beta hCG, Estriol
higher than normal MSAFP is correlated with neural tube defects
lower than normal MSAFP is correlated with multiples, trisomy, (not as reliable)
or
“Quadruple Marker” aka “Multiple Marker”
adds Inhibin-A to Triple Marker
most common cause of abn result is inaccurate LMP date
GCT
OGTT
24-28 weeks Glucose Challenge Test (GCT) 50g oral glucose solution (Glucola) Blood glucose at 1 hr Abnormal if > 130-140 mg/dl
Oral Glucose Tolerance Test (OGTT) if symptomatic or significant hx or elevated GCT 100g oral glucose solution Blood glucose at 1 hr, 2 hr, 3 hr Abnormal if > 180 mg/dl at 1 hr > 155 mg/dl at 2 hr > 140 mg/dl at 3 hr
