week 12: antenatal assessment in pregnancy Flashcards
antenatal
Prenatal, before birth
conception
Fertilization in oviduct; sperm + egg = blastocyst
implantation
Blastocyst’s chorionic villi attach to uterus, develops into membranes
Placenta = Chorion + Amnion
preg test
Human Chorionic Gonadotropin (hCG) is the earliest indicator of pregnancy
Comes from the placenta and tests recognize its presence
Otherwise, Progesterone is responsible for pregnancy maintenance - but it’s always there
gravidity
pregnancy
gravida
Woman who is pregnant
primigravida
1st pregnancy
multigravida
2+ pregnancies
nulligravida
Never been pregnant
parity
Number of pregnancies (not fetuses) where the fetus/es reaches 20 gestational weeks
- Legal viability is reaching 20 weeks pregnancy - whether the fetus is born alive or still
- Twins would still being 1 parity, if a fetus suddenly dies at 30 weeks it’s still parity
primi/multi/nullipara
One, 2+, 0 pregnancies reach viability
For multi, it’s really 22-25 weeks as they’re more likely to survive
Lungs aren’t mature at 20 weeks; past 24 weeks it’s better
preterm
Pregnancy delivered between 20-36 weeks
term
Delivered from wks 37-42 (42 is late)
postdate/term
Pregnancy beyond 41 weeks (Canada) or 42 weeks (US)
viable
Capable of living outside of the uterus; from 22-25 weeks
GTPAL Scale
3-1-0-1-3
Gravidity: Number of all pregnancies (regardless of term, birth, miscarriage)
Term Births: Number of deliveries from wks 36-42
Preterm Births: Number of deliveries from wks 20-36 (viability -> 36)
Abortions/Miscarriages: Total number of miscarriages/abortions
Living Children: Number of living children
In the above example:
The woman has only given birth once - therefore triplets
She has miscarried once at another pregnancy
There is no outcome for her 3rd pregnancy: She is currently pregnant
pregnancy
Spans 9 months or 10 lunar months (28 days each; 280 days)
Trimesters:*
1st: Wks 1-13
2nd: Wks 14-26
3rd: Wks 27-40 (term babies)
presumptive signs of preg
Felt by the woman
Missed periods
Home pregnancy test positive
Morning sickness, breasts tender, fatigue, peeing urgency/frequency
Quickening: 14-20 weeks in, woman feels fetal movement
probable signs of preg
Observed by the examiner
Uterine enlargement (measured from the pubic symphysis up)
Positive hospital pregnancy tests for hCG
Braxton Hicks contractions: Irregular tightenings of muscular uterine layer; birth prep
Changes in pigmentation
Chadwick’s Sign (Colour): Labia, vagina, cervix turn purple/blue; fill with blood, signs of vascular congestion due to changing hormones
Goodell’s Sign (Growth): Hypertrophy (growing) and engorgement of vessels resulting in significant softening of the cervix - as always, due to hormones
Hegar’s Sign: Examiner palpates softening of lower uterine segment; 6-8th week
positive signs of preg
Actually from the fetus
Fetal heartbeat that isn’t the mother’s (110-160bpm)
Fetal movement felt by the examiner
Visualization (ultrasound)
Cord, amniotic volume, baby breathing, tone, etc… # of fetuses
naegele’s rule
Used to calculate; not totally exact
Take the first day of last period - 3 months + 7 days + 1 year
Or first day of last period + 9 months + 7 days
Ex., April 2nd, 2019 -> January 9th, 2020 - most give birth in +/- 7 days of that number
prenatal data
biological data
gynecological data
obstetric history
genetic history
medical history
infectious diseases
nutritional habits
personal habits
exercise habits
enviro habits
family roles/relationships
psychosocial considerations
cultural/spiritual considerations
developmental considerations
objective data in women preg
Diluted haemoglobin, but levels remain the same (because of higher BV)
Lower BP, Higher HR
Peripheral edema
Normal if standing for a while
Problem if swollen after lying down - check BP; body isn’t coping properly
preg lab tests
Rubella Titre (MMR test)
Complete Blood Count (CBC); for anemia, infection
Blood Type & Rhesus factor - abnormal antibodies
Rhesus Positive blood has an extra protein; if dad is + and mom is -, she can form antibodies against Rh+ blood which is a risk for the next pregnancy
STI Tests: Syphilis, Gonorrhea, Chlamydia, HSV, CMV, HBV
Serum glucose (for gestational diabetes), Glucose tolerance test (sugary drink)
Urinalysis and culture (check for UTI, urine contents)
HIV/AIDS screening
preg uterus
Changes in size, shape, position (starts to rise from the pubic symphysis at 12 weeks)
Braxton Hicks contractions (caused by OXT)
Measure Uteroplacental Blood Flow - HTN, Intrauterine Growth Restriction, Diabetes, Twins
HTN will inhibit ability of fetus to grow
Cervical Changes (Chadwick’s, Goodell’s signs); mucus plug
Quickening (fetal movements)
preg breasts
Fullness, heaviness - larger because of hormones
Heightened sensitivity; tingling and pain
Areolae are more pigmented (So baby can find it)
Montgomery’s Tubercles: Bumps around areola; secrete bacteriostatic; keeps infections low
Colostrum: Pre-milk substance by last trimester; prepares for production
High in antibodies and seals baby’s gut
preg CV
BP is the same, BV increases (though Hb dilutes), Cardiac Output increases
Circulation, Coagulation times - Increased risk of clotting
preg resp
Pulmonary function (breathing)
BMR increase (because the fetus is a parasite)
Nasal stuffiness due to hormone changes
preg kidneys
Higher output of urine - drink fluids + electrolytes to replace
Higher filtration
preg skin
Chloasma: Mask of pregnancy (hyperpigmentation on face)
Linea nigra: From pubic symphysis up to uterus
Striae gravidarum: Stretch marks
Palmar erythema: Redness in hands
chloasma
Mask of pregnancy (hyperpigmentation on face)
linea nigra
From pubic symphysis up to uterus
striae gravidarum
Stretch marks
palmar erythema
Redness in hands
MSK preg
Joints loosen up to adapt to load; wider stance and waddling
Neuro preg
No change unless BP increases, Pain, numbness (due to pressure), headaches
GI preg
Fluctuations in appetite (starts with decrease)
Pica: Craving non-food; chalk, dirk
Swelling gums - Check dental care for calcium (Does NOT affect teeth)
Displacement of intestines, stomach -> Acid reflux, constipation, ab pain
Gallbladder, liver impact
endocrine
Hormonal state; increased metabolism, ++PRL, OXT, Cortisol …
weight gain preg
Recommended around 25-35lbs* on average
Fetus = 7.5 lbs, Placenta = 1.5lbs, Amniotic Fluid = 2lbs, Uterus = 2.5lbs
Breasts = 3lbs (one cup size), Blood Volume = 2-4lbs, Fluid/Fat = 4-9lbs
Decreases after delivery
fetal assessment
Quickening (movements at 14-22 weeks)
Heart sounds (10-12wks with Doppler ultrasound, Fetoscope)
Fetal Crown to Rump measurement (with ultrasound)
Biparietal diameter (Widest transverse diameter of head at 12-13 weeks with ultrasound)
Fundal height (where the uterus is)
maternal and paternal roles
Accepting pregnancy (father is delayed until they actually hold the baby)
Identifying mother/father role
Smoking, habit changes, nesting (mother), doing what’s “good for the baby”
Reordering personal relationships
Emotional relationship with fetus (mother moreso; softening hormones like Progest./Est)
Preparing for childbirth
sibling adaptation
Sibling jealousy; normal
grandparent adaptation
Some are happy, unhappy about it
1st trimester discomforts of preg
- Nausea, vomiting - Hormones change, fatigue, emotional factors, carbohydrate metabolism
Have a dry cracker/toast before rising - keep blood sugar regular
Small, frequent meals, avoid greasy, flavourful food - Nasal stuffiness (hormones): Use a vaporizer
- Breast tenderness: Have a well-fitting bra
- Urinary frequency/urgency: Due to bladder pressure (wks 1-12, 3rd trimester)
Limit fluids in evening, caffeine
Respond to voiding urgencies immediately
Kegel exercises to strengthen pelvic floor
Report symptoms of UTI - Increase vaginal discharge (leucorrhea):
Have good hygiene, wear cotton underwear (reduces chances of UTI)
2nd and 3rd trimester discomforts of preg
- Heartburn (displacement and relaxed sphincters)
Have antacids with no sodium (ask HCP), small meals, upright, avoid fat/fried - Constipation (from iron supps, intestinal displacement + sluggish bowels)
- Increase fluids and fibre
- Hemorrhoids (due to pressure on pelvic veins)
Treat constipation, don’t stand for too long, wear constrictive clothing - Backaches (at lumbosacral curve):
Avoid heels, have good posture + body mechanics - Leg cramps (pressure, poor circulation, fatigue)
Rest with legs up, warm clothing and exercise - Shortness of Breath (dyspnea) (due to diaphragmatic pressure)
Semi-Fowler’s position (15-45° upright), change posture - Ankle Edema (due to poor venous return)
Rest with legs up, avoid tight clothing
nursing care management preg
Identify existing risk factors/deviations from normal to promote health
Emphasize preventative and self-care
Prenatal care is often sought by middle, wealthy SES
Impoverished women may not have as much access to public, private care (lower SES)
SDH; lack of culturally-sensitive care, commute, travel/transport
Fewer positive outcomes and more complications
follow up visits preg
Monthly until last month; then every 2 weeks
First one is an interview
Subsequent ones are physical examinations, fetal assessments
Fundal height, gestational age, health status
Fetal development
follow up visits preg
Monthly until last month; then every 2 weeks
First one is an interview
Subsequent ones are physical examinations, fetal assessments
Fundal height, gestational age, health status
Fetal development
