W2: Prenatal Concept/ Antepartum Care Flashcards
Preconception care
identifying and modifying risk factors in individuals considering pregnanvy in order to improve their health
8 Components of Preconception Care
Folic Acid
Healthy Body Weight
Mental Health
Physical Activity
Smoking
Immunizations
Nutrition
Environmental Hazards
Folic Acid
reduces risk of neural tube defects
Healthy Body Weight
high/low BMI can negatively affect pregnancy
Mental Health
premature birth
birth weight
breastfeeding initiation
coginitive & emotional development
Physical Activity
decrease risk of chronic conditions
weight
mental health
Smoking
less negative effects on pregnancies
maternal health
Immunizations
adverse pregnancy outcomes
prevent infections from being transmitted to fetus
protection durign early infancy
Nutrition
overall health
optimize maternal & fetal health
Environmental Hazards
complex to verify but should be done
Conception and Implantation Phases
unfertilized oocyte
fertilized oocyte
two cell stage
four-cell stage
eight cell stage
morula
blastocyte
embryo hatches
vlastocyte rotates and impants into endometrium of uterus
6 functions of the placenta
respiratory - O2 and CO2
excretory - waste products
endocrine- functions as an endocrine - secretes 4 pregnancy hormones (human chorionic gonadotropin, estrogen, progesterone, human placental lactogen)
nutrition: mother- fetus
storage- carbs, protein, Ca, Fe for fetal needs
barrier- from harmful substances
CHEAP.TORCHES acronym
C:chickepox & shingles
H: hepatitis B, C, D, C, E
E: enterovirus + poliovirus
A: aids
P: parovirus B19 (5th disease)
T: toxoplasmosis
O: other -group B streptococcus listeria, candida
R: rubella
C: cytomegalovirus
H: herpes simplex virus
E: sexually transmitted- gonorrhea, chlamydia
S: syphilis
Antepartum:
prenatal period (conceptio - onset of labor)
AKA antenatal, prenatal
Intrapartum
period from onset of true labour - delivery of baby & placenta
post partum
6 week period: delivery of placenta - body returning to pre-pregnancy state
First trimester
1-14 weeks
Second trimester
14-28 weeks
Third trimester
28-40 weeks/delivery
Gravida
a person who is pregnant
Gravidity
pregnancy
nulligravida
a person who has never been pregnany and is not pregnant currently
primigravida
a person who is pregnant for the first time
multigravida
a person who has had 2+ pregnancies
parity
number of pregnancies where the fetus has reached 20 weeks gestation
nullipara
person who has not completed a pregnancy beyond 20 weeks
primipara
one pregnancy reaching 20 weeks
multipara
2+ pregnancies reaching 20 weeks
viability
capacity to live outside the uterus
Infants born at __ - ___ weeks of gestations infants are considered to be on the threshold of viability
22, 25
pre-term
20 - 36 + 6 w
late pre-term
34- 36+6 w
term
37 - 40 + 6w
early term
37 - 38 + 6w
full term
39 - 40 + 6w
late term
41st w
post-term
after 42w
GTPAL Score: Amy is pregnant for the first time
1, 0, 0, 0, 0
GTPAL Score: Amy carries her pregnancy to term, new born survies
1, 1, 0, 0, 0
GTPAL Score: Amy is pregnant with second child
2, 1, 0, 0, 0
GTPAL Score: Amy has a child, her current pregnany ends in a miscarriage at 10 weeks
2, 1, 0, 1, 1
GTPAL Score: Amy has one child, she is pregnant for the third time and gives birth to twins at 36 weeks
3, 1, 2, 1, 3
What does GTPAL Score stand for
gravidity
term
pre-term
Abortion
Living children
earliest biochemical marker of pregnancy
human chorionic gonadotropin (hCG)
Technology used for home pregnancy tests
ELISA, enzyme linked immunoabsorbent assay
Presumptive Signs of Pregnancy
cessation of menses
nausea and vomiting
frequent urination
breast, chest tenderness
skin changes
quickening
fatigue
Probable Signs of Pregnancy
enlargement of abdomen
braxton hicks (end of 1st tri)
skin changes (striae, increased pigment)
positive pregnancy test
hegar’s test
goodell’s sign
chadwick’s sign
hegar’s sign
palpable softening of lower uterine segment @ 6 weeks
goodell’s sign
softening of cervix @ 8 weeks
chadwick’s sign
blue-violet hue form congestation on vulva, vagina, cervix, vaginal opening @ 6-8 weeks
Positive Signs of Pregnancy
fetal heart heard
-4-8w w/ ultrasound
-10-12w w/ doppler
fetal movement (18-20w)
visualization of fetus (5-6w)
Adaptations: Uterus
changes in size, shape, position
hegar’s sign
changes in contractility
goodell’s sign
changes r/t fetal presense (ballotement) - displacement of abdominal structures
Adaptations: Vagina & Vulva
chadwick’s sign
leukorrhea
Adaptations: Breasts
fullness, heavtt
heightened sensitivity (tingling, pain)
areaola more pigmented
mongomery tubercules
colostrum
Adaptations: Cardiovascular System
slight change in diastolic pressure
-slight decrease mid-preg, return to normal by end
blood volume increases
hemoglobin level decreases
hematorcrit decreases
RBC mass increase
cardiac output increases
— all mainly due to increased fetal demand
Adaptations: Respiratory System
oxygen consumption increases
changes from abdominal-thoracic breathing (diaphragm displaced)
increases vascularization in upper tract d/t estrogen
nasal & sinus stuffiness, nosebleeds, voice changes
Adaptations: Renal System
increased GFR
increase frequenct & nocturemia (pressure on bladder)
dilation of ureters & renal pelvis increase pylonephiritis
Adaptations: endocrine system
thyroid- enlarge, tt4 inc
adrenal- cortisol & aldosterone inc
pituitary- gland enlarges, prolactin inc
pancreas- glucose for growth
hyperglycemia & hyperinsulinemia after eating (insulin resistance)
potential for gestation diabetes
Adaptations: GI system
morning sickness due to hCG
constipation
gas, discomfort
risk of gallstones
heartburn
hiatus hernia
mouth, gum soreness/bleeding
hemarroids
Adaptations: Musculoskeletal System
lumbar lordosis as uterus enlarges & moves upwards & outwards
relaxation of motility of pelvic joints (waddle)
rectis abdominous, diastasis recti
umbilicus protrudes
Adaptations: neurological system
lightheadedness, fainting
carpal tunnel
sensory changes in the legs
headaches
decrease attention, concentration, memory
Adaptations: Integumantary system
chloasma
linea negra
striae gradrium (stretch marks)- reduced conenctive tissue strength d/t elevated steroid levels
thicker hair
Determining date of delivery
nagele’s rule
add 7 days to 1st day of LMP
substract 3 months from that date
fundal height
measures size of uterus from pubic symphysis to fundus
22-34w
mcdonald’s method: using a tape measure
Quickening
awareness of fetal mocements by pregnant person
16-22 weeks
hormones of pregnancy
HPL
HCG
Estrogen
Preogesterone
oxytocin
prolactin
relaxin
HPL
metabolism regulation-free up glucose for fetus use
insulin resistance
HCG
proliferation of uterus & causes cessation of menstruation
estrogen
increases at end of pregnancy for labor
maintains, controls, stimulates the production of other pregnancy hormones
ensures developmnt of fetal organs
growtth & function of placenta
maternal breast tissue growth (lactation)
progesterone
!! maintains pregnancy
growth of blood vessels
nutrients for erly embryo
thickening of endometrium for implantation
establish placenta
prevents uterus from contracting until labor
prevents lactation until PP
strengthen pelvic muscles for labor
oxytocin
produced by hypothal. secreted py posterior pituitary
induced uterine contractions for labor
letdown reflex during lactation
prolactin
produced by anterior pituitary
essential for milk production
relaxin
produced by corpus luteum then placenta after 6-8 weeks
relaxes pelvic muscles/joint for birth
An infant has a lpw birth weight when they weigh ___
2500g or less
BMI Classification
<18.5 = underweight
18.5 - 24.9 = normal
25-29.9=overweight
>30= obese
per week weight gain for each BMI category
underweight= 0.5
normal= 0.4
overweight= 0.3
obese= 0.2
total weight gain range for each bmi category
underweight= 12.5-18
normal= 11.5-16
overweight= 7-11.5
obese= 5-9
Foods to avoud during pregnancy
blue cheese
unpasteurized milk
raw/undercooked eyes
raw/undercooked meat
shark/sword fish (mercury)
limit intake of tuna & mackerel
limit coffee intake (lbw)
no alcohol
limit intake of liver (to much vit A)
Common Discomforts during pregnancy
nausea/vomiting
heartburn
breast tenderness
vaginal d/c, bleeding
headaches
nosebleeds
gingivitis
abdominal pain/cramping
fatigue
constipation
urinary frequency
backpain
skin changes
pytalism
quickening
pica
Prenatal Visit Frequency
1x per month until 28w
q2w 28-36w
1x week 37-40w
Normal Fetal Heart Rate: Pregnancy
160-170 bpm (early)
110-160 bpm (late)
Screening: 1st Trimester
PAP
CBC
HIV
urine culture
rubella titre
ABO & RH typing
STI
ultrasound NT, B-hCG, PAPP-A
- Aneuploidy= increased NT , inc B-hCG, reduced PAPP-A
Screening: 2nd Trimester
quadruple screen: blood test
- alpha fetal proteins (AFP), h-CG, unconjugated estriol (UE), inhibin-A (placental hormone)
ultrasoung (getational age, growth, abnormalities, heart)
Ultrasound
1st Trimester: assess gestational age, number of fetuses, assess for problems (ectopic, bleeding)
2nd/3rd: gestational age, level of amniotic fluid, location of placenta, identify presentation, cause of bleeding, fetal death
amniocenthesis
part of amniotic fluid is taken to test for genetic disorders, congentical abnormalities
Screening: 3rd trimester
gestational diabetes
group b streptococcus
fetal health (fetal movement counts, NST, CST, ultrasound)
6 practices for culturally safe, humble, trauma-informed perinatal care
cultural safety + humility
self-determination
trust through relationship
respect
anti-indigenous reacism
strength & resilience based practice
